Manual therapy often’… Actual loss insurance that is constantly leaking”/>
As of the first half of this year, it was found that more than 70% of actual loss insurance premiums for orthopedics and family medicine were paid for non-covered treatment. The rapid increase in non-coverage treatment, such as manual therapy and extracorporeal shock wave therapy, is being pointed out as a major factor in the leakage of actual cost insurance.
On the other hand, the ratio of non-covered medical expenses for ophthalmologists, which exceeded 70% until 2022, plummeted to the 20% range.
According to the non-life insurance industry on the 5th, the actual loss insurance paid out in the first half of this year, compiled by five non-life insurance companies, including Samsung Fire & Marine Insurance, Hyundai Marine & Fire Insurance, KB Non-life Insurance, DB Non-life Insurance, and Meritz Fire & Marine Insurance, was KRW 4.9439 trillion, 8.3 trillion won more than the same period last year. % increased.
Of these, salary payments were KRW 2.0875 trillion and non-salary payments were KRW 2.8564 trillion. The ratio of non-benefit insurance payments increased slightly from 57.6% in 2023 to 57.8% in the first half of this year.
The departments with the highest ratio of non-covered medical expenses were orthopedics (71.0%) and family medicine (70.4%). Insurance money for these two subjects alone accounts for 22.5% of the total insurance money.
This is believed to be because non-covered physical therapy costs, such as manual therapy, growth therapy, and extracorporeal shock wave therapy, account for about 20% of actual loss insurance premiums. In particular, the Department of Family Medicine performed a wide range of manual therapy and non-covered injection treatments, resulting in a high non-coverage rate.
On the other hand, ophthalmology, where the non-coverage ratio was as high as 76.9% in 2022, plummeted to 28.2% last year and 28.9% in the first half of this year. Non-reimbursement insurance benefits for ophthalmology decreased from 456.4 billion won in 2022 to 54.7 billion won last year and 31.4 billion won in the first half of this year.
Previously, non-coverage price inflation due to excessive cataract surgery was serious, but after the 2022 Supreme Court ruling that ‘hospitalization treatment is not necessary’, the actual loss insurance compensation standards were strengthened, which has had the effect of eliminating many excessive cataract surgeries.
However, as the pattern of new non-coverage fads is repeated, it is pointed out that price regulation related to non-coverage medical expenses and the use of standard names and codes related to non-coverage are ultimately necessary.
According to the non-coverage report data from the National Health Insurance Corporation for the second half of last year that Kim Yoon, a member of the Democratic Party of Korea, received from the National Health Insurance Corporation, the gap in non-coverage medical expenses between medical institutions has widened by up to 300 times. The median price for manual therapy was 90,000 won and the maximum was 1.5 million won, and the median price for extracorporeal shock wave therapy was 70,000 won and the maximum was 500,000 won.
An insurance industry official said, “If regulation of non-coverage is not implemented, the supply of non-coverage will expand even if there is similar covered treatment. This ultimately directly leads to the burden of national medical expenses due to an increase in actual loss insurance premiums, so price control is necessary to prevent abuse of non-coverage and actual loss insurance.” “he said.
Reporter Park Geun-ah [email protected]
