Last Year Health Insurance Coverage Rate 64.2%... 'Moon Care' Goal Achieved Narrowly

Total Medical Expenses 103.3 Trillion Won, Health Insurance Contributions 66.3 Trillion Won
Increase in Non-Covered Items like Clinic-Level Nutrient Injections Limits Growth Rate

Comparison of Health Insurance Coverage Rates for Clinics and Hospitals in 2018 and 2019

[Asia Economy Reporter Choi Dae-yeol] Last year, the health insurance coverage rate was identified as 64.2%, an increase of 0.4 percentage points compared to the previous year. By the size of medical institutions, the increase was mainly in large hospitals, and among diseases, health insurance covered a larger proportion for severe and high-cost treatment diseases with heavy medical expenses. However, the increase in non-reimbursed services, such as pain and nutritional injections, which are frequently performed at local clinics, limited the rise in the coverage rate.

According to the analysis of last year's health insurance patient medical expenses survey released on the 29th by the Health Insurance Research Institute of the National Health Insurance Service, the total medical expenses during this period amounted to 103.3 trillion won, with the insurer, the NHIS, covering 66.3 trillion won. Non-reimbursed medical expenses were 16.6 trillion won, and statutory copayments were 20.3 trillion won.

The health insurance coverage rate refers to the proportion of total medical expenses (excluding general pharmaceuticals, prosthetics for cosmetic purposes, herbal medicine costs for health promotion, etc.) covered by health insurance (excluding medical aid, industrial accidents, automobile insurance, etc.). President Moon Jae-in has emphasized the so-called 'Moon Care' plan, aiming to increase this rate to 70% during his term. The plan is to apply health insurance to non-reimbursed services, which patients currently pay for entirely despite medical necessity, thereby reducing patient burden.

Although the coverage rate slightly increased compared to 63.8% in 2018, the growth rate has slowed. Compared to 2017, the coverage rate increased by 1.1 percentage points in 2018, but last year it only rose by 0.4 percentage points. Seonam-gyu, head of the Medical Security Research Office at the Health Insurance Research Institute, said, "While high-cost non-reimbursed services were converted to reimbursed and managed in 2018, the scale of non-reimbursed services recovered last year was relatively small," adding, "Selective non-reimbursed services at the clinic level have continuously increased, offsetting the effects."

President Moon Jae-in is speaking at the 2nd anniversary performance report meeting of the Health Insurance Coverage Enhancement Measures held in July last year.

At relatively large medical institutions such as tertiary general hospitals, general hospitals, and hospitals, the coverage rate increased by 0.8 percentage points, 1.5 percentage points, and 3.4 percentage points, respectively. For hospitals and above, the coverage rate was 64.7%, up 1.6 percentage points from the previous year. In contrast, the coverage rate for long-term care hospitals dropped by 1.4 percentage points to 68.4%, and clinics decreased by 0.7 percentage points to 57.2%. This is interpreted as the coverage being strengthened mainly in large medical institutions where treatment for severe diseases with high medical costs is more common.

On the other hand, the decrease in clinic-level coverage rate was due to an increase in treatments not covered by health insurance, such as injection fees for pain or nutritional injections, rehabilitation, and physical therapy. Seon said, "Last year, the application of health insurance to hospital-level medical institutions' premium rooms, ultrasound for upper abdomen, lower abdomen, and emergency severe patients, as well as head and neck and abdominal MRI, resulted in some control over non-reimbursed medical expenses," but added, "Selective non-reimbursed services, which have strong patient preference, increased, mainly at the clinic level, so proper management of low-cost selective non-reimbursed services is necessary."

The coverage rate for the 'Top 30 high-cost treatment diseases per capita,' including leukemia and pancreatic cancer, rose by 0.1 percentage points to 81.3%, while the coverage rate for the 'Top 50 diseases' remained the same at 78.9%. By age group, the coverage rates for vulnerable groups such as children under 5 years old (69.4%) and seniors over 65 years old (70.7%) were higher than the national average (64.2%). In particular, the coverage rate for infants under 1 year old was 79.4%, an increase of 5.2 percentage points from the previous year.

Seonamgyu, Director of the Medical Security Research Office at the Health Insurance Policy Research Institute (left), is briefing on the results of the health insurance patient medical expense survey on the afternoon of the 29th at the Government Sejong Complex in Sejong City.

The health insurance coverage rate has remained in the low 60% range: 63.6% in 2010, 63.0% in 2011, 62.5% in 2012, 62.0% in 2013, 63.2% in 2014, 63.4% in 2015, 62.6% in 2016, 62.7% in 2017, and 63.8% in 2018. The average among OECD countries is around 80%. The government has set a goal to raise it to 70% by 2022 and is converting various non-reimbursed items into reimbursed services.

Following the elimination of selective treatment fees and the application of health insurance to upper abdominal, brain, and vascular ultrasounds, last year the coverage was expanded to include urological and lower abdominal ultrasounds, 2- and 3-person rooms at local hospitals, emergency rooms, intensive care units, and infertility treatment procedures. The total medical expenses reduced for Korean citizens through coverage enhancement measures have been estimated at 4 trillion won. Medical expense reductions for vulnerable groups such as children and the elderly amounted to 1.4 trillion won, and cost reductions through converting non-reimbursed services to reimbursed services were 2.6 trillion won. The NHIS stated that health insurance finances are being managed stably within the originally planned scope. As of the end of last year, the financial balance showed a deficit of 2.8 trillion won, and the accumulated reserves were 17.7 trillion won, improving by about 300 billion won compared to initial expectations.

Seon said, "The government is seriously aware of the increase in selective non-reimbursed services," adding, "They are working on identifying all non-reimbursed services and standardizing the items that occur differently in hospitals, considering various management mechanisms such as price disclosure management, quality control, and evaluation according to the nature of the services."

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