[Editorial] Boosting fiscal integrity for medical insurance

A woman in her 40s based in Daegu made 2,050 hospital visits last year. She went around five to six clinics a day and received medical care up to 10 times a day. She regularly received physical therapy and anesthetic jabs. She cost the public health insurance 26.9 million won ($20,688), 18 times the average annual medical fee of 1.49 million won subsidized to national insurance subscribers.

The case was shared by the Ministry of Health and Welfare in a hearing on measures on sustainable medical insurance.

Outpatient care in Korea is exceptionally high compared to other countries. Outpatient visits per person averaged 14.7 days in 2020, topping the frequency rate among OECD member countries whose average was 5.9 days per year.

Medical care shopping has posed a problem for a long time, but it has not gotten any better due to loopholes in the system. Even when visiting clinics and hospitals every day, out-of-pocket payment stops at a mere 20 to 30 percent. Care could be nearly free if one is covered by their loss insurance policy in which actual spending in clinics, hospitals and pharmacies can be claimed. The ministry proposes to up the out-of-pocket rate to 90 percent if outpatient visits exceed a certain limit.

The so-called Moon Jae-in care — the national healthcare system under the previous government — has been disputed. After magnetic resonance imaging (MRI) and ultrasound examinations were included in the coverage, payouts to the two categories jumped to 1.85 trillion won last year from 189.1 billion won in 2018. The expanded healthcare has helped broaden access to expensive health care, but also caused unnecessary waste. Less budget and investment went to serious and urgent diseases, child deliveries, and infant care. The ministry plans to strengthen the guidelines for brain and cerebrovascular MRI coverage.

Non-Koreans’ free-riding on Korea’s generous public healthcare system has also been discussed. A foreigner can subscribe to public health care if he or she resides in Korea for more than six months. But there is no such residing requirement for dependents. To become a dependent, family members, except for minors, should have stayed in the country for more than six months under new criteria. Although public health care system should not discriminate against foreigners, abuse of the system also should be prevented.

National health insurance finance must stay sustainable against a fast-aging society. Authorities must make sure they are not overburdened. The government must consider toughening rules for excess use by further raising the out-of-pocket rate beyond the proposed threshold.