[Reporter’s Notebook] Simplifying Claims for Silson Medical Insurance... Medical Community Says "Fintech Promotion" Is Off-Topic

Legislative Stalemate for Over 10 Years Due to Opposition from the Medical Community

Oh Hyung-gil, Political Economy Department Reporter

[Asia Economy Reporter Oh Hyung-gil] "Instead of legislating the claims process for indemnity insurance, it should be transformed into a new business model where claims are made through fintech companies, allowing costs to be charged to customers."

There are concerns that legislative discussions on the long-stalled 'digitalization of indemnity medical insurance claims' may once again come to a standstill. The medical community, which has opposed claims digitalization, is now presenting the argument that claims digitalization should be fostered as a new business in the fintech sector, causing the discussions to become chaotic and disorganized.

On the 12th, the Korean Medical Association, together with Min Hyung-bae, a member of the Democratic Party of Korea, held a forum titled "What is the problem with mandating private (indemnity) insurance claims by medical institutions?" where they argued that the digitalization of indemnity insurance claims "conflicts with existing medical laws and poses a risk of patient personal information leakage."

They also raised concerns about the misuse and centralization of medical information. They claimed that the government could infringe upon the business models of medical IT and fintech companies currently providing claims digitalization services.

However, the medical community's argument is inherently contradictory. Under the Medical Service Act, it is generally prohibited for anyone other than the patient to access or receive copies of patient records. By the same logic, transmitting information to fintech companies cannot be considered legal.

Moreover, it is practically impossible to guarantee that there will be no risk of leaks such as hacking during the digitalization of medical information by private companies. Especially since indemnity insurance contracts are maintained for a lifetime after subscription, there is no assurance that private companies can provide the same service for decades.

The logic even reverses the causal relationship that fintech companies started related businesses to address consumer inconvenience amid the reality that claims digitalization for indemnity insurance is blocked by the medical community.

The medical community is secretly uneasy about the Health Insurance Review and Assessment Service, which collects medical information, being able to view all non-reimbursable items if digitalization proceeds. However, this can be addressed by including multiple safeguards in the amendment, such as prohibiting use outside of duties, banning centralization, forbidding disclosure of secrets by related parties, and including penalty clauses.

Annually, the number of indemnity insurance claims reaches 100 million. Considering only paper documents like medical receipts or detailed statements, it is estimated to exceed 400 million sheets per year. Due to the obstinacy of the medical community, administrative costs are ultimately passed on to consumers. Most indemnity insurance subscribers want the claims process simplified. For consumer convenience, it must not be delayed any longer.