[News Terms] Excessive Medical Use, 'Patient Copayment Rate' Raised Up to 90%

'Out-of-pocket rate' refers to the cost that an individual must pay directly when receiving medical services. It indicates the proportion of the total medical expenses that the patient pays out of pocket after excluding the costs covered by health insurance.

There are various types of out-of-pocket rates, such as the 'out-of-pocket rate for medical consultation fees,' which is the percentage an individual pays when receiving general medical treatment at a healthcare institution; the 'out-of-pocket rate for drug costs (pharmaceuticals),' which is the percentage an individual pays when purchasing prescribed medication; and the 'out-of-pocket rate for hospitalization fees,' which is the percentage an individual pays for medical expenses incurred during hospitalization.

Park Min-su, Vice Minister of Health and Welfare, is announcing the 2nd Comprehensive Health Insurance Plan at the Government Seoul Office on the 4th.
[Photo by Yonhap News]

On the 4th, the government announced that it will promote the 2nd Comprehensive National Health Insurance Plan (2024?2028), which includes measures to increase the out-of-pocket rate for health insurance subscribers who use medical services excessively or for medical procedures with low necessity, and to return part of the insurance premiums paid by subscribers with low medical usage as 'vouchers' that can be used for health management.

To prevent excessive medical use, the government plans to introduce a service that informs health insurance subscribers once per quarter about their cumulative outpatient visits, hospitalization days, health insurance benefit costs, and out-of-pocket payments through KakaoTalk, Naver, and 'The Health Insurance' application (app). This is intended to encourage individuals who use medical services excessively to self-monitor and use medical services rationally. As of 2021, the average annual outpatient visits per Korean was 15.7 times, nearly three times the OECD average of 5.9 times.

The Ministry of Health and Welfare has decided to increase the out-of-pocket rate for individuals who use medical services excessively or for medical procedures with low necessity. Starting in July, the out-of-pocket rate for outpatient visits for individuals with more than 365 visits per year will be raised from the usual level of about 20% to 90%. Additionally, a plan to increase the out-of-pocket rate if physical therapy is used more than once per day at a single institution is also expected to be implemented.

The Ministry also plans to support individuals with low medical usage by providing vouchers worth up to 120,000 KRW annually, equivalent to 10% of the insurance premiums they have paid. Vouchers will be given to those who visit medical institutions less than once per quarter and no more than three times per year, which can be used at medical institutions or pharmacies. If the vouchers are not used due to no medical visits, they can be used later.

Park Min-su, the 2nd Vice Minister of the Ministry of Health and Welfare, explained, "This is intended to provide incentives to those who manage their health well and do not frequently use medical institutions," adding, "Since returning 10% in full would be too large an amount, we set a cap at 120,000 KRW."

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