[Viewpoint]Low health costs are a social investment

What was good in the beginning can sometimes turn out to be a source of trouble with the passage of time. The fixed-amount medical fee payment system of health insurance is one of those things. When a patient goes to a medical clinic for relatively minor medical care that costs less than 15,000 won ($16), the patient pays 3,000 won. The remainder is paid by the National Health Insurance Corporation. This is called a fixed-amount payment system for medical expenses.
When the medical fee exceeds 15,000 won, a patient has to pay 30 percent of the medical care expenses; thus, the amount borne by the patient jumps abruptly to 4,500 won or more.
In other words, under this structure, the more serious the illness, the higher the fee a patient must pay.
When the fixed-amount medical fee payment system for outpatient services was introduced in 1986, the fixed amount was 2,000 won. The average medical fee at that time was 4,000 won, so it was not an insignificant amount. It was equivalent to 50 percent of the basic medical service cost, if converted to a fixed rate system.
The reason for keeping the fixed amount high was to prevent people from going to hospitals frequently for minor illnesses, such as the common cold. Today, 20 years later, the average medical fee has gone up three times, but the fixed amount patients have to pay has increased by only one-and-a-half times.
As a result, outpatients with serious illnesses pay 30 percent of the medical fee, while those with minor illnesses pay only 20 percent.
A system that was made to prevent people from misusing the insurance system for minor illnesses has ended up becoming a discount system for the treatment of colds.
This problem was pointed out quite a long time ago. But there has been no change until now. What is the reason?
First, there is a group of people who study the mood of voters who do not want to pay even a small amount of extra payments now.
Then there are government officials who neglect their duty to fix discrepancies in the medical insurance system.
It is a good thing when patients see a reduction of what they have to pay out of their total medical fees.
However, if it means that patients have to pay more for the treatment of serious illnesses, then it is a matter that needs rethinking.
It would be good if we could reduce the patients’ burden for simple illnesses as well as serious illnesses, but in order to achieve that, people have to pay more health insurance premiums.
The system in Western European countries, where people pay 15 percent of their salary as a health insurance premium and enjoy the benefits of paying less than 20 percent of their medical fees, belong in this category.
However, who would willingly pay more for health insurance? It is hard to expect politicians and civic organization leaders to take such a stand, because they are worried about what people will think.
It is not possible to reduce patients’ medical fees without increasing health insurance premiums.
However, if we increase the load for those who do not feel it burdensome and decrease how much will be borne by those who feel it more, we can increase the society’s efficiency as a whole. This is one way by which we can increase the efficiency of distribution of social benefits under the discipline of the budget.
That would probably amount to the same idea as the administrative efficiency of health insurance that civic organizations have demanded as a precondition for an increase in health insurance premiums.
Ultimately, it is a matter of deciding whose burden to increase and whose burden to decrease.
The first idea that comes to mind is increasing the burden of the wealthy, while decreasing that of the poor, but this has already been reflected to a certain degree when the health insurance premiums were set to be proportionate to income.
The health insurance system is not a system for punishing the wealthy.
The second thing that comes to mind is the crippling structure of the fixed-amount medical fee payment system.
The social efficiency of the health insurance system will improve if the rate that patients with serious illnesses have to pay is reduced to a lower level than that for patients with minor illnesses. Otherwise, an undesirably reversed burden structure will be established in the medical insurance system.
If we can prevent household bankruptcies caused by illness through redistribution of resources in favor of patients with serious illnesses, social capital will increase.
Bankruptcies of households with leukemia and hemophilia patients impede social integration. It is not right for society to watch unconcerned when people are dying because they can’t afford expensive drugs.
If the money from increasing the fixed amount of payments by patients with simple colds is used to ease the burden on child patients or to promote their health, it will be an investment in human capital.
Restructuring the existing medical fee payment system will show that the country is heading toward a social investment system that concentrates on increasing social and human capital.
If reducing health insurance premiums by increasing the financial burden of patients is a neo-liberal idea, and minimizing the patients’ burden by maximizing health insurance premiums is a classical welfare state practice, then trying to create social capital and human capital for the future through the social solidarity of equitable health insurance premiums is what a “social investment country” should aim for.

*The writer is a professor of public health administration at Yonsei University. Translation by the JoongAng Daily staff.

by Jeong Hyoung-sun