[VIEWPOINT]Expanding insurance is too costlyControversy has arisen surrounding the estimated charges for food to patients covered by health insurance. The government proposed a price range of 3,390 won ($3.50) to 6,000 won, but the hospitals are saying that is not enough money because it is lower than the current rate, which does not get covered by insurance, and will lead to lower-quality hospital food.
Considering the vivid memory of the financial crisis of the National Health Insurance Corporation just a few years ago, hearing the news that the corporation would cover the hospital food makes us feel uneasy.
The financial crisis in 2001 was caused by changes such as the division of medical and pharmaceutical services, the integration of regional and employee health insurances and an aging society. The government took every available measure, such as raising insurance premium rates, reducing the range of insurance coverage, freezing medical fees and expanding financial support from the national treasury.
Attributed to those endeavours, the National Health Insurance Corporation could manage to break even in 2004, two years earlier than expected. Last year, the accounts were in the black and as long as there are no abrupt factors, the structure of the accounts will remain intact in this year as well.
Encouraged by this financial improvement, the budget authorities are trying to reduce the annual government subsidy of 4 trillion won ($4.1 billion) or reduce coverage, noting the law establishing the health insurance fund expires this year. The Ministry of Health and Welfare has expressed disapproval over such reductions.
The controversy over the hospital food is directly linked to the essence of the medical insurance system, which is “the range covered by the insurance and the way to accumulate the fund.”
Efforts such as reducing the financial burden on cancer patients since the end of 2004 are laudable. The corporation increased the portion of medical expenses it covered from 61 percent to 65 percent.
But at the same time, the insurance system has limits. The principles for the expansion of insurance coverage are not clear.
Focusing on helping critical patients, such as those with cancer, a heart illness or a brain disorder is persuasive. However, the criteria to expand the medical care and pharmaceutical coverage in general seems unclear. No cost-benefit studies have been done about such an expansion.
The authority seems to have been trying to flatter the labor unions, doctors or the patients’ group, which have been speaking in loud voices.
Squandering health insurance money for birth incentives, such as exempting the fees for a natural delivery or the treatment fees for children under 6, does not look good, either. Since the criteria are vague, there is no persuasive answer for patients, such as the elderly who need artificial teeth, teeth scaling, ultrasonic treatment or treatment for various rare and incurable diseases, when they complain, “Why aren’t we covered by insurance?”
A roadmap for strengthening the insurance coverage was presented last year, but it is already showing problems.
A group of three critical diseases designated for concentrated treatment was supposed to be increased to around 10 diseases by 2008, but the authorities have even failed to identify diseases to be added this year, because there are not big diseases like cancer that can be easily identified. In other words, the start and finish of things are the other way around.
In order to lead the health insurance system properly, we have to consider the management of the entire system.
Vague decisions such as raising the insurance rate to 71 percent coverage by 2008 will only produce a lot of quick fix policies.
Finances should be estimated based on variables like low birth rates, an aging society and slow economic development, and financial supplies and insurance expansion plans should be established based on such estimates.
The priorities of insurance expansion should also be decided according to the medical effects and the amount of burden on the patients. Deciding the maximum amount of money a patient should bear is a good method too.
Giving most of the aid to people in the lower income brackets, which the budget authorities suggest, is a bad idea.
That would result in higher insurance premiums for the middle and upper classes, and these people are already paying as much as 314 times more medical insurance premium than the people in the lower-income bracket.
This is too much of a difference. In Japan, for example, the difference is just 11 times.
Using social insurance for income redistribution distorts the original nature of the insurance. It is better to give medical aid to people with lower incomes who cannot afford to pay insurance premiums and exempt them from insurance fees altogether.
Instead, we should restrict expenses such as high-price prescriptions, expand the inclusive medical treatment-fee system, provide effective administration of the National Health Insurance Corporation and introduce a contract system for medical treatment facilities.
Expanding insurance coverage can lead to an increase in the unnecessary use of medical services. It is essential to take measures to stop them.
The expenditure on health insurance has doubled in the last five years. There is no guarantee that the financial ruin of 2001 will not be repeated if we expand medical coverage without devices and rules that can restrict expenditure.
If the health insurance has another financial crisis, it will be the patients that will ultimately suffer from the damages.
* The writer is an editorial writer of the JoongAng Ilbo.
by Shin Sung-shik