"Get More Treatment"... Minor Injuries from Car Accidents, Oriental Medicine Treatment Costs Rise from 190 Billion to 740 Billion Won in 5 Years

Set Claims Receiving More Than 6 Types of Treatments Quadruple in 5 Years
Hospitals Increase and Patients Decrease... Competition to 'Raise Unit Prices'

The medical expenses claimed from insurance companies for traditional Korean medicine 'set treatments' by minor injury patients in car accidents have surged from around 190 billion KRW to 740 billion KRW over the past five years. This increase is attributed to a decrease in the number of patients alongside a rise in medical institutions, leading to ongoing competition to raise unit prices, as well as the absence of established treatment fee standards, resulting in continued excessive treatment.

On the 2nd, the Korea Insurance Research Institute published a report titled "Status and Implications of Set Claims for Traditional Korean Medicine Treatments in Automobile Insurance," analyzing approximately 9.9 million treatment fee statements for victims with injury grades of 9 or below, who account for 75% of the medical expenses for bodily injury compensation under automobile insurance from 2017 to 2022.

According to the report, the scale of set claims for minor injury patients with injury grades 12 to 14, mostly sprains or contusions, increased from 192.6 billion KRW in 2017 to 744 billion KRW last year, an average annual growth of 31%. The 'set claims' made at Korean medicine clinics and hospitals refer to the practice of simultaneously administering multiple (usually six or more) treatments such as acupuncture, moxibustion, cupping, herbal medicine, pharmacopuncture, and Chuna manual therapy to a patient in a single visit (once per day) and claiming the fees from insurance companies.

According to the Korea Insurance Research Institute, set claims have already become the norm. Expanding the scope to patients with injury grades 9 to 12, the amount claimed through set treatments increased nearly fourfold from 202.7 billion KRW in 2017 to 802.7 billion KRW last year, accounting for more than half (54.8%) of the total traditional Korean medicine treatment expenses. As of last year, the proportion of multiple treatments involving two or fewer types was only 2.24%, down to about half compared to 4.36% in 2017. The representative treatment rates for acupuncture, moxibustion, and cupping each fell below 1%.

Within set claims, there was a notable difference in medical expenses. In particular, the per-case treatment costs for patients receiving 3 to 5 types of multiple treatments and those claiming sets of six or more types were approximately 1.66 to 2.16 times higher. Jeon Yong-sik, Senior Research Fellow at the Korea Insurance Research Institute, analyzed that this difference was due to whether herbal medicine was included. Excessive prescriptions of herbal medicine have driven up the medical expenses.

The increase in set claims is primarily attributed to the rise in the number of traditional Korean medicine institutions. As the number of providers increased and competition intensified, individual medical institutions appeared to raise their 'unit prices.' According to the Korea Insurance Research Institute, as of last year, there were 14,549 Korean medicine clinics and 564 traditional Korean medicine hospitals, increasing by 438 and 234 respectively compared to 2017. Meanwhile, the number of patients has been declining, from 790,000 in 2018 to 758,000 in 2020.

Above all, the limited review standards for multiple treatments are considered the key reason for the increase in set claims. Due to restrictive review criteria for multiple treatments, perpetrators (insurance companies) have raised objections to the fees for traditional Korean medicine treatments, but these concerns have not been reflected in the treatment fee standards, leading to the rise in set claims.

Senior Research Fellow Jeon pointed out, "Although individual regulations exist for major traditional Korean medicine treatments, there are no review standards reflected in automobile insurance treatment fees for various combinations such as concurrent use of major treatments. If multiple treatments like set claims continue, complaints from perpetrators regarding victim treatments may increase, so it is necessary to explore ways to manage this."

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