Effect of suppressing 4th generation actual loss of non-covered medical treatment
Suspicion of overtreatment remains in hospitals and Seoul
“We need to review the adequacy of non-covered medical expenses.”
Asia Today Reporter Seonyoung Lee = The 4th generation actual cost medical insurance was found to be effective in suppressing non-covered medical treatment.
However, overtreatment of patients with 4th generation actual loss insurance was suspected in hospitals by medical institution and in Seoul by region. It was also seen that health insurance medical expenses and auto insurance medical expenses for treatment of the same injury, such as a sprain, were more than double. It is argued that the appropriateness of non-covered medical expenses should be reviewed to curb overtreatment.
On the 24th, Insurance Research Institute Senior Research Fellow Jeon Yong-sik and Insurance Research Institute Research Fellow Kim Gyeong-seon published a report titled ‘Status of non-covered medical treatment under 4th generation medical expense insurance: Focusing on sprains and strains.’ The ratio of non-coverage to medical expenses under 4th generation medical expense insurance is different on average. It was revealed that non-reimbursement for sprain and strain treatment is being managed to some extent as it is low compared to the previous generation.
According to the Insurance Research Institute, the ratio of non-benefit to medical expenses for 4th generation actual loss insurance was calculated to be 48.9% on average. It is lower than group actual loss (53.4%), second generation (52.8%), and third generation (49.4%).
However, it was analyzed that there was overtreatment in hospitals by type of medical institution and in Seoul by region.
Among tertiary general hospitals, general hospitals, hospitals, and clinics, the proportion of non-coverage compared to non-coverage among patients receiving treatment in hospitals reached 58%. The proportion of patients with a non-reimbursement rate of more than 25% was 38%, which was higher than the 1st generation (33%), 2nd generation (33%), and 3rd generation (32%).
By region, the median medical cost for 4th generation medical insurance patients treated in Seoul was the highest at 264,000 won. The non-metropolitan area was 225,000 won, which was lower than the Gyeonggi area (234,000 won).
Senior Research Fellow Jeon and Research Fellow Kim said, “The purpose of non-benefit management of the 4th generation actual cost medical insurance appears to be effective for patients with sprains and strains, but there is a need to continue to review non-benefit management and adequacy to suppress overtreatment in the mid to long term.” pointed out.
They suggested that there is a need to find ways to curb the incentives for excessive medical treatment arising from non-covered physical therapy and injection drugs. In addition, it was said that there was a need to consider allowing rate adjustments within 5 years, provided that certain statistical requirements are met.
It is argued that in the mid to long term, the adequacy of medical expenses not covered by health insurance needs to be reviewed.
It is pointed out that for the same injury such as sprain and strain, the cost of medical treatment under auto insurance and health insurance is twice that of the difference. The health insurance medical expenses for patients with sprains and strains, which are classified as minor injuries under auto insurance, amount to approximately 600,000 won. Among these, non-covered medical expenses amount to about 300,000 won. On the other hand, medical treatment costs for car insurance patients are only about 300,000 won.
Jeon Senior Research Fellow and Research Fellow Kim said, “According to the argument of the medical community, treatment for auto insurance patients is difficult due to the uniqueness of their injuries and medical costs should be high, but the medical costs for health insurance patients with actual cost medical insurance are higher due to non-reimbursement,” adding, “Population “Medical expenses are increasing due to the aging population, and there is a need to find ways to manage medical expenses for health insurance and auto insurance,” he said.
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## PAA Questions:
## World Today News Interview: Exploring the Impact of Suppressing Non-Covered Medical Treatment
**Introduction:**
Welcome to World Today News. Today we’re diving deep into the complex issue of non-covered medical treatment in South Korea, specifically focusing on the impact of the 4th generation actual cost medical insurance. Joining us are two experts:
* **Senior Research Fellow Jeon Yong-sik** from the Insurance Research Institute, and
* **Research Fellow Kim Gyeong-seon**, also from the Insurance Research Institute.
Thank you both for being here today.
**Section 1: Effectiveness and Unintended Consequences**
* **Host:** The article states that the 4th generation actual loss insurance seems effective in suppressing non-covered treatment for sprains and strains. Could you elaborate on the specific mechanisms behind this effectiveness?
* **Host:** However, the article also raises concerns about potential overtreatment, particularly in hospitals and certain regions like Seoul. What factors might be contributing to this overtreatment despite the insurance system’s design?
**Section 2: Regional and Institutional Disparities**
* **Host:** The research highlights a significant difference in median medical costs for 4th generation insurance patients between Seoul and non-metropolitan areas. How might these regional variations be explained, and what are the implications for healthcare access and equity?
* **Host:** Similarly, the study indicates discrepancies in non-coverage rates among different types of medical institutions. What are your thoughts on the factors driving these disparities, and could they point to systemic issues within healthcare delivery?
**Section 3: Cost Containment and Adequacy of Coverage**
* **Host:** The article mentions a stark difference in medical costs for the same injury (sprains and strains) when comparing health insurance and auto insurance patients. Can you shed light on the reasons behind this discrepancy and explore its potential implications for both patients and the overall healthcare system?
* **Host:** Looking ahead, what concrete steps can be taken to address the concerns about overtreatment and ensure the long-term sustainability of the 4th generation actual cost medical insurance system?
**Section 4: Public Perspective and Policy Recommendations**
* **Host:** Beyond the technical and systemic aspects, how do you think the public perceives the current state of non-covered medical treatment in South Korea? Are there any misconceptions or concerns that need to be addressed?
* **Host:** Based on your expertise, what specific policy recommendations would you suggest to policymakers in order to strike a better balance between managing healthcare costs and ensuring patients receive appropriate and necessary care?
**Conclusion:**
Thank you both for providing such invaluable insights into this crucial issue. We hope this discussion has shed light on the complexities of non-covered medical treatment in South Korea and encouraged further dialog around finding sustainable solutions. To our listeners, we encourage you to stay informed and engage in the conversation surrounding healthcare policy.
