4th Anniversary of 'Moon Jae-in Care' Implementation... 37 Million People Benefited from 9.2 Trillion Won

President Moon Jae-in [Photo by Yonhap News]

[Asia Economy Reporter Lee Chun-hee] The achievements of the so-called 'Moon Jae-in Care,' officially known as the 'Health Insurance Coverage Enhancement Measures,' have been revealed on the 4th anniversary of its implementation. From 2018 to last year, over 37 million people, accounting for more than 70% of the population, benefited from a reduction in medical expenses totaling 9.2 trillion KRW.

The Ministry of Health and Welfare and the National Health Insurance Service summarized and disclosed the results of the 4th anniversary of the health insurance coverage enhancement measures on the 12th. In August 2017, the Ministry announced coverage enhancement measures aimed at creating a "reliable country without worries about hospital bills," converting non-covered medical services, which patients had to pay for entirely, into covered services under health insurance, and reducing medical expenses for vulnerable groups such as the elderly, children, women, and low-income households. These measures were promoted until 2022, focusing on ▲ converting non-covered services to covered services ▲ reducing out-of-pocket expenses for vulnerable groups ▲ strengthening the medical safety net.

First, the conversion of non-covered services to covered services focused on non-covered items with high medical cost burdens and high coverage needs, especially severe diseases. To resolve the so-called 'three major non-covered services'?selective treatment fees, premium hospital room charges, and nursing care fees, which impose a particularly heavy burden on the public?selective treatment fees were abolished, health insurance was applied to 2-3 person rooms in hospitals and above, and the number of beds covered by integrated nursing and care services was more than doubled to over 60,000 beds. Additionally, health insurance was gradually applied to necessary non-covered items such as ultrasound and MRI examinations, reducing medical expenses for the public.

As a result, the health insurance coverage rate at tertiary general hospitals rose from 65.1% in 2017 to 69.5% in 2019, and at general hospitals from 63.8% to 66.7%. However, since this coverage conversion focused on hospital-level and severe patients, the coverage rate at clinics, which treat relatively mild patients, remained low at 57.2% in 2019. This is notably lower than the overall coverage rate of 64.2%.

Regarding this, Sung Chang-hyun, Director of the Preliminary Benefits Division at the Ministry of Health and Welfare, explained, "Coverage has been prioritized for severe patients and inpatients with high medical necessity, and coverage is being expanded starting from these areas. Since the low coverage rate at clinics cannot be considered unproblematic, it is regarded as an issue that requires continuous review."

Significant conversion to covered services was also made to alleviate the medical expense burden for vulnerable groups. For children, the out-of-pocket rates for inpatient care for those under 15 years old, outpatient care for those under 1 year old, and outpatient care for premature and low birth weight infants were greatly reduced. Health insurance was also applied to dental cavity treatments.

For the elderly, the out-of-pocket rate for severe dementia treatment was lowered from 20-60% to 10%, and coverage for dentures and implants was reduced from 50% to 30%. For persons with disabilities, the scope of covered assistive devices was expanded, and the average benefit amount for prosthetic arms and legs was increased by 22.8%.

To strengthen the medical safety net, the government lowered the annual out-of-pocket ceiling for health insurance premiums for the bottom 50% income group to about 10% of their annual income, expanding refunds for low-income groups. Accordingly, the ceiling for the lowest income quintile (bottom 10%) was reduced from 1.22 million KRW to 800,000 KRW. The ceilings for the 4th and 5th quintiles were also lowered from 2.05 million KRW to 1.5 million KRW.

Additionally, the catastrophic medical expense support project, which assists with therapeutic non-covered medical expenses, expanded its coverage from the four major severe diseases?cancer, heart disease, brain disease, and rare incurable diseases?to all diseases, and raised the support limit from 20 million KRW to 30 million KRW.

The government disclosed that as a result of these coverage enhancement measures, approximately 37 million people benefited from a reduction in medical expenses totaling 9.2 trillion KRW from 2018 to last year. Despite these achievements, the government evaluated that the health insurance finances were managed stably within the expected range at the time of planning.

As of the end of last year, the health insurance reserve fund stood at about 17.4 trillion KRW, an improvement of approximately 2.7 trillion KRW compared to the 14.7 trillion KRW projected when the first comprehensive health insurance plan was established in 2019.

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Lee Joong-kyu, Director of the Insurance Benefits Division at the Ministry of Health and Welfare, stated, "The accumulated surplus is larger than the expected deficit," adding, "While continuous monitoring has had an effect, the biggest factor was related to COVID-19." Due to the spread of COVID-19, citizens strictly followed personal preventive measures such as wearing masks and hand washing, which led to a sharp decline in respiratory diseases. Consequently, fewer illnesses occurred and fewer hospital visits were made, resulting in cost savings.

The government plans to raise the health insurance coverage rate, which increased from 63.8% in 2018 to 64.2% in 2019, to 70% by next year. Director Sung explained, "Achieving 70% is a challenging and difficult goal, but we plan to pursue a strategy focused on essential benefits and develop management measures to achieve the target as much as possible for other areas, with continuous scheduling for expanding coverage."

Minister Kwon Deok-cheol of the Ministry of Health and Welfare said, "We will continue to strive to ensure that patients in need receive sufficient support through the reduction of medical expenses resulting from enhanced coverage." Kim Yong-ik, President of the National Health Insurance Service, also stated, "We will do our best to steadily carry out the remaining tasks by next year to create a reliable country without worries about hospital bills.”

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