The Flawed 'Moon Care'... Public Funds Leaking Due to Lax Review Process

[Asia Economy Reporter Baek Kyunghwan] It has been confirmed that excessive spending occurred as the Moon Jae-in administration's health insurance coverage enhancement policy, known as 'Moon Jae-in Care,' expanded insurance coverage for ultrasound and magnetic resonance imaging (MRI). The Board of Audit and Inspection revealed that not only was expenditure control lacking, but revenue was also overestimated, exposing the flaws of 'Moon Care.' They suggested the need for an external control system to reduce health insurance financial expenditures.

On the 28th, the Board of Audit and Inspection announced the results of the 'Health Insurance Financial Management Audit' containing these findings.

According to the Board of Audit and Inspection, the Ministry of Health and Welfare excessively paid compensation to the medical community during the implementation of Moon Jae-in Care. When eight types of ultrasound and three types of MRI examinations were covered by insurance in 2018, the Ministry anticipated a decrease in medical revenue and prepared a compensation plan totaling 190.7 billion KRW annually. However, the audit analysis showed that the number of brain MRI procedures actually increased, and medical revenue rose by 79%, from 427.2 billion KRW in 2017 to 764.8 billion KRW in 2019.

Problems were also revealed in the review of covered items. The Board of Audit and Inspection examined samples of five ultrasound types conducted between April 2018 and March 2021, and MRI scans taken from October 2018 to March 2020, finding suspected violations of coverage standards amounting to 160.6 billion KRW. Despite the Ministry's inability to fully verify compliance with coverage standards due to insufficient IT systems, the audit pointed out that reviews were completed without any adjustments.

When calculating the compensation scale for male reproductive organ ultrasounds, it was also found that only data from a specific academic society, a stakeholder group, was reflected without sufficient verification. The Board of Audit and Inspection compared this data with samples from 11 university hospitals and estimated that 7.4 billion KRW in compensation was excessively paid from September 2019 to December of last year.

Additionally, the National Health Insurance Service's financial forecasts were found to lack accuracy. Expenditures were underestimated, and revenues were overestimated. The Board of Audit and Inspection stated, "If recalculated, the expected cumulative reserve fund in 2025 would be 13.4997 trillion KRW, which is 2.4603 trillion KRW less than the previous forecast of 15.96 trillion KRW," criticizing that internal and external verification has not been properly conducted.

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