The Core of Health Insurance Reform: Preventing Medical Shopping and Over-Treatment... Concerns Over Increased Premiums and Reduced Coverage

Focus on Health Insurance Financial Soundness
"Burden Increases Without National Treasury Maintenance or Support Expansion," Opposition Arises

On the 15th, merchants at Cheongnyangni General Market in Dongdaemun-gu, Seoul, are watching the live broadcast of the 1st National Task Inspection Meeting chaired by President Yoon Seok-yeol. Photo by Hyunmin Kim kimhyun81@

The core of the health insurance reform revealed by President Yoon Suk-yeol is essentially focused on the 'abolition of Moon Care' and the financial soundness of health insurance. Because of this, opposition parties and the political sphere, as well as labor and civil society groups concerned about health insurance premium increases, are expected to continue their backlash.

Progressive organizations, including the Korean Confederation of Trade Unions (KCTU), argue that without maintaining or expanding government subsidies, the burden of health insurance premiums on the public will ultimately increase. The government has decided to initiate social discussions on the upper limit of health insurance premiums and to promote discourse on premium rates.

The upper limit of premium rates in South Korea is 8%, which is low compared to major countries in 2021 (Germany 14.6%, France 13.0%, Taiwan 5.17%, Japan 9.21%). On the other hand, the ratio of government subsidies is currently 14%, which is lower than France's 52.2%, Japan's 38.8%, and Taiwan's 22.9%.

The amendment to the National Health Insurance Act proposed by Shin Hyun-young, a member of the Democratic Party of Korea, aims to raise the government subsidy rate for health insurance to 17%. The Korean Medical Association holds the position that the government subsidy rate should be increased to 20%. Because of this, concerns have been raised that health insurance premiums will rise, increasing the burden on the public.

Minister of Health and Welfare Cho Kyu-hong explained at the national task review meeting that the role of health insurance has not been reduced. Minister Cho said, "What we are trying to reform is to continue supporting essential and severe medical care for the public, not a reduction in role but to enhance sustainability," adding, "However, it is to prevent medical abuse and identity fraud."

A citizen who said they are caring for their mother in her 90s asked, "I recently read an article saying that health insurance finances are depleted, so benefits will be reduced and premiums increased," and added, "As we grow older, we are worried about increasing hospital bills and premiums."

Criticism from opposition parties regarding President Yoon's revision of Moon Care is also growing. Former Democratic Party lawmaker Choi Min-hee appeared on the radio and said, "During the five years of the Moon Jae-in administration, 20 trillion won was spent on strengthening coverage, but health insurance finances did not collapse, and medical expenses for the public decreased," and added, "Last year, health insurance finances had a surplus of 2.8 trillion won; I hope the officials reported accurate data to the president."

Professor Kim Yoon of Seoul National University's Department of Health Care Management said on a radio program, "If the expansion of existing health insurance coverage is rolled back, from the public's perspective, the burden of medical expenses will increase, and they will be unable to receive necessary treatments or tests, so the rollback itself is undesirable," and added, "Many people are already benefiting, and this is not medical abuse but receiving necessary treatment, so politically taking away the benefits provided by health insurance is not feasible."

However, there is consensus on the need to prevent medical shopping and excessive treatment. At a forum jointly hosted by the National Health Insurance Service and the Korean Academy of Medical Sciences on the 15th, opinions were expressed that, to reduce excessive medical care, the development of appropriate treatment lists should go beyond and be applied in medical practice.

Park Byung-gyu, head of the Appropriate Treatment Office at the National Health Insurance Ilsan Hospital, said, "It is important not just to create wise choice recommendations but to include them in the hospital treatment process," adding, "Many parts of the recommendations are already well known and many are already being implemented." Oh Seung-jun, academic director of the Korean Medical Association, said, "Discussions to use limited medical resources efficiently are being actively promoted. The president also mentioned that he would lead the reform," adding, "If wise choices are not established, limited medical resources will be wasted." On this day, the Korean Academy of Medical Sciences also presented recommendations to authorities to prevent excessive health checkups.

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