Did French and British Doctors Oppose the Digitization of Real-Expense Insurance Claims?

Ahead of Overseas Private Health Insurance Claim Simplification
'Medical Community Opposition' Korea Submits Documents for 10 Years

[Asia Economy Reporter Oh Hyung-gil] In France, insurance subscribers pay medical expenses to medical institutions after treatment and claim insurance benefits through an electronic information transmission system between 'medical institution-intermediary organization (Health Insurance Corporation)-insurance company.' The Health Insurance Corporation has established and manages the electronic information transmission system (NOEMIE) as an intermediary for electronic claims by insurance subscribers and provides services through contracts with insurance companies. Medical institutions create electronic treatment charts through the electronic information transmission system (SESAM-Vitale) and send them along with electronic claims to the intermediary Health Insurance Corporation (CPAM).

In the United Kingdom, medical institutions directly claim insurance benefits from insurance companies through an electronic information transmission system between 'medical institution-intermediary organization (intermediate payment company)-insurance company' after treating insurance subscribers. The simplification of computerized claims has improved consumer convenience as well as benefited medical institutions.

As the computerization of indemnity medical insurance claims overseas has enhanced consumer convenience, there are calls for Korea to expedite its introduction.

Jung Sung-hee, Research Fellow at the Korea Insurance Research Institute, and Moon Hye-jung, Researcher at the Korea Insurance Research Institute, argued in their report titled "Cases and Implications of Computerized Claims in Overseas Private Health Insurance" that financial authorities should establish institutional measures aimed at social convenience for the computerization of indemnity medical insurance claims.

Currently, in Korea, a bill to simplify indemnity insurance claims has been proposed for 12 years but remains pending in the National Assembly due to opposition from medical organizations.

The report diagnosed that "because electronic information exchange between medical institutions and insurance companies does not occur, consumers continue to face the inconvenience of submitting related documents directly to insurance companies."

Domestically, since 2018, insurance companies have been striving to implement computerized claims for indemnity medical insurance through voluntary partnerships with medical institutions and information and communication technology (ICT) providers, but no significant results have been achieved so far. By the end of last year, only about 150 medical institutions participated in computerized claims out of a total of 96,000 medical institutions and pharmacies.

Researcher Moon said, “The computerization of indemnity medical insurance claims aims to enhance convenience between claimants and payers of insurance benefits,” adding, “To ensure effective compliance with standards, the relevant laws should clearly define the scope of application and establish regulations that intermediaries must follow.”

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