3 Million Patients Spending Over 5 Million Won on Medical Bills... 6% of Patients Account for Half of the Medical Expenses

NHIS and HIRA, 2019 Health Insurance Statistical Yearbook
Elderly Population Increased by 5% While Medical Expenses Rose by 12%

Status of Per Capita Medical Expenses under Health Insurance Last Year

[Asia Economy Reporter Choi Dae-yeol] It has been identified that nearly 3 million patients incurred medical expenses exceeding 5 million KRW over the past year. These high-cost patients accounted for about half of the total health insurance medical expenses.

According to the 2019 Health Insurance Statistical Yearbook released on the 12th by the National Health Insurance Service and the Health Insurance Review & Assessment Service, the number of health insurance patients last year was 48.328 million, and the medical expenses excluding non-covered and medical aid were recorded at 86.111 trillion KRW. The number of patients was almost the same as in 2018, but medical expenses increased by more than 10%.

The number of patients whose medical expenses exceeded 5 million KRW last year was 2.988 million, accounting for 6.2% of all patients. Considering that the number of patients who spent over 5 million KRW in 2018 was about 2.57 million, this represents an increase of more than 16%. The medical expenses incurred by patients with over 5 million KRW in expenses last year amounted to 41.1869 trillion KRW, accounting for 47.8% of the total.

By age group, the trend of increasing medical expenses for the elderly is steep. The elderly population aged 65 and over last year was 7.46 million, increasing by about 5% over one year, while elderly medical expenses rose by more than 12% to 35.7925 trillion KRW. Compared to 2015, elderly medical expenses have increased by 1.6 times over five years. The average annual medical expense per elderly person also steadily increased to 4.91 million KRW.

Last year, the annual insurance premium per health insurance beneficiary was recorded at 1.154212 million KRW. During the same period, the annual benefit per person was 1.346744 million KRW, showing that the benefits received were about 1.17 times higher than the premiums paid. The total insurance premium assessed last year was 59.1328 trillion KRW, an increase of 9.7% from the previous year, with 86% coming from workplace insurance premiums and the remaining 14% from regional insurance premiums.

Last year, the medical expenses reviewed for medical institutions amounted to 85.7498 trillion KRW, about a 10% increase from the previous year. Medical institutions accounted for about 79%, and pharmacies about 21%. By type of medical institution, general hospitals and clinics saw medical expenses increase above the average, while tertiary general hospitals, hospitals, long-term care hospitals, and Korean medicine institutions showed increases below the average.

Among medical institution treatment items, treatment and surgery fees accounted for 19.4%, surpassing consultation fees (19.1%) as the highest expenditure in benefits. The proportion of treatment and surgery fees increased by 0.6 percentage points compared to the previous year. During the same period, MRI fees also increased by 0.6 percentage points, and examination fees by 0.3 percentage points. Among clinics, medical expenses increased more significantly in psychiatry, urology, and ophthalmology compared to other fields.

The number of births last year was 300,787, about 8% less than in 2018. In 2018, natural births exceeded cesarean sections by about 18,000 cases, but last year, cesarean sections were about 3,000 cases more. The prescription rates for injections and antibiotics for acute upper respiratory infections (surveillance) have generally decreased over recent years, but antibiotic prescriptions slightly increased at hospital and clinic levels.

The number of patients treated for 12 chronic diseases, including hypertension and diabetes, was 18.8 million, about 4% higher than the previous year. Medical expenses amounted to 34.5297 trillion KRW, increasing by more than 10% during the same period. Among chronic diseases, hypertension patients were the most numerous, followed by arthritis (5.02 million), mental and behavioral disorders (3.35 million), neurological diseases (3.28 million), diabetes (3.22 million), and liver diseases (1.96 million). In terms of growth rate, chronic kidney disease (9.8%) and liver disease (10.5%) patients increased significantly.

This content was produced with the assistance of AI translation services.