Management of Health Services Uncovered by National Health Insurance

Abstract

a provision for medical institutions to report items, amounts, and details of uncovered medical expenses to the Minister of Health and Welfare was newly established in the Medical Law. This paper aims to estimate the scale and trend of out-of-pocket expenditures for uncovered medical items; to review the government's plans as well as related literatures for the management of uncovered medical items; and to gather opinions at expert meetings. Of the total current health expenditures in 2019, household out-of-pocket was 47.5 trillion won (30.3%), and "out-of-pocket excluding cost-sharing" was 26.3 trillion won (16.8%). The decrease in household out-ofpocket burden over the past 2 decades has been replaced by the increase of private health insurance premiums, suggesting that the policy has not been sufficiently connected to the burden relief of low-income households. Whether covered or uncovered, a medical item is located at a point in the continuous spectrum between necessity and selectivity. It is most logical to classify medical items according to the size of "necessity of treatment, " and determine the level (height) of co-payment rate accordingly. A medical item changes its position on the necessity-selectivity spectrum. It is a limitation in terms of classification. Suggestions: First, "medical items for which the treatment necessity is confirmed" should be covered by public health insurance, subject to quality management and differential co-payment rates. Second, "items with relatively weak treatment necessity", currently not covered, should be switched to coverage once their therapeutic natures are confirmed, though their co-payment rates are set high in order to induce "cost-conscious" medical use of patients. Third, even in the case of "items remaining uncovered", policy measures as follows are required from the perspective of consumer protection: informed consent, data submission, and monitoring when they are provided together with covered items, etc.

Improving quality of life for a patient with fibromyalgia and their caregiver: A protocol for the application of the integrative medical service model

“…[ 2 ] Unfortunately, the current healthcare system fails to provide sufficient methods or services to address this burden. [ 3 ] Nevertheless, medical experts agree that diverse forms of healthcare services are required for patients with major severe and geriatric chronic diseases and their caregivers. [ 4 ]…”

“…[2] Unfortunately, the current healthcare system fails to provide sufficient methods or services to address this burden. [3] Nevertheless, medical experts agree that diverse forms of healthcare services are required for patients with major severe and geriatric chronic diseases and their caregivers. [4] Against this background, we conducted a national study in Korea to determine a method and framework for developing an integrative healthcare service model for patients with the 4 major severe and geriatric chronic diseases.…”

Introduction to methodology for the development of an integrative medical service model

“…2 However, the treatment currently being received by patients with four major serious diseases in Korea is mainly Western-style, and only a few hospitals provide Korean and Western medicine collaboration. 3 As a result, this means that the treatment direction is being chosen by doctors, and the importance of trying various therapeutic approaches for patients living with lifelong diseases is overlooked. 4 Accordingly, the government recognized the need for a new concept of medical service support while supporting treatment costs for patients with four major diseases and related research and field investigations.…”