[2020 National Audit] "1,000 Annual Visits for Sprains, Health Insurance Leakage" Criticized, "Will Increase Out-of-Pocket Expenses"

National Assembly Health and Welfare Committee Member Kim Mi-ae of the People Power Party <이미지:Yonhap News>

[Asia Economy Reporter Choi Daeyeol] To manage patients who excessively visit medical institutions even for minor illnesses, the National Health Insurance Service (NHIS) has decided to establish a separate organization. This decision was made based on the judgment that such excessive medical users could negatively impact the health insurance finances. Increasing the out-of-pocket rate is also being considered.

At the NHIS national audit held on the 20th, Kim Mi-ae, a member of the People Power Party, pointed out that the NHIS’s burden has increased as medical expenses rose mainly due to excessive medical users. According to data submitted by the NHIS to Rep. Kim, the number of patients with more than 70 outpatient visits per year increased by about 5%, from 1.52 million in 2017 to 1.6 million last year. During the same period, the amount borne by the NHIS out of the total medical expenses rose by 25%, from 4.3548 trillion KRW to 5.4494 trillion KRW.

As of last year, the average outpatient medical expense per insured person was about 750,000 KRW, but for excessive medical users, it was found to be nearly six times higher, reaching 4.33 million KRW. Rep. Kim cited the case of a 68-year-old female dependent identified during the audit preparation process, saying, "Due to a sprain, she visited medical institutions 1,084 times in the past year, averaging more than three visits per day, and out of the total medical expenses of 19.12 million KRW, the NHIS covered 16.74 million KRW."

According to Rep. Kim, about 200,000 people had 150 to 364 outpatient visits annually. There were also 2,820 people who visited medical institutions more than once a day for 365 days or more. Rep. Kim criticized that although excessive medical use is worsening the health insurance finances, the NHIS has not presented any substantial measures. Apart from sending notices or providing consultations by phone, no active measures are being taken.

Rep. Kim stated, "A dedicated team should be separately formed within the NHIS to enable follow-up management, and a penalty measure that increases the out-of-pocket rate should be considered if the same diagnosis is treated at the same level of medical institutions beyond a certain standard, excluding cancer and rare diseases." Kim Yong-ik, the NHIS chairman, acknowledged Rep. Kim’s points and said he would consider establishing a separate team within the NHIS and also look into lowering the out-of-pocket rate.