[Getting Insurance Savvy] Flood of Korean Medicine Hospitals for Traffic Accidents... Medical Community Also Points Out Issues

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[Asia Economy Reporter Oh Hyung-gil] The cost of Korean traditional medicine treatments under automobile insurance is rapidly increasing every year, raising calls from the medical community for countermeasures.

The increase in the operation of single rooms in Korean traditional medicine hospitals and the lack of clear treatment fees or detailed recognition criteria were cited as reasons for the significant rise in Korean traditional medicine treatment costs.

Recently, the Korean Medical Association's Medical Policy Research Institute published a policy issue analysis report titled "Current Status and Problems of Korean Traditional Medicine Treatments under Automobile Insurance," reviewing the status and issues of Korean traditional medicine treatments.

According to the "2020 Automobile Insurance Treatment Cost Statistics" published by the Health Insurance Review and Assessment Service (HIRA), the proportion of medical institutions claiming automobile insurance is significantly higher in Korean traditional medicine than in Western medicine. Clinics accounted for 17.62%, whereas Korean traditional medicine hospitals and clinics accounted for 96.83% and 82.54%, respectively.

The performance of Korean traditional medicine treatments under automobile insurance has sharply increased over six years from 2014, when HIRA began compiling automobile insurance review performance data, to 2020. The number of claim statements increased by 158.8%, treatment costs by 331.5%, inpatient and outpatient days by 171.7%, cost per treatment by 66.7%, and cost per inpatient/outpatient day by 58.8%.

In 2020, for the most frequent automobile insurance diagnoses, the cost per treatment for dislocation, sprain, and strain of joints and ligaments in the neck area (ranked first) and lumbar and pelvic joints and ligaments (ranked second) was more than twice as high in Korean traditional medicine compared to Western medicine for both outpatient and inpatient care.

Overall, the number of beds in Korean traditional medicine has increased. In particular, the number of advanced beds in Korean traditional medicine clinics has rapidly increased. The number of Korean traditional medicine beds rose by 76.7%, from 17,901 in 2014 to 31,636 in 2020.

Since 2019, advanced beds in Korean traditional medicine hospitals have all been operated as single rooms, and notably, the number of advanced beds in Korean traditional medicine clinics increased by 120.4% in one year, from 861 in 2019 to 1,898 in 2020. It is known that a significant portion of these are single rooms.

Along with this, prescriptions for herbal decoctions under automobile insurance are increasing. The proportion of decoction costs in Korean traditional medicine treatment costs under automobile insurance was about 24% in 2019, the highest, and decoction treatment costs more than doubled from 74.7 billion KRW in 2014 to 231.6 billion KRW in 2019.

There are no clear treatment fees or detailed recognition criteria for automobile insurance treatment fees. Specifically, the current automobile insurance fee standards lack appropriate prescription criteria related to decoctions, and there are no specific limits or recognition criteria for treatments such as pharmacopuncture, Chuna manual therapy, or Korean traditional physical therapy.

The analysis report pointed out the need for measures related to Korean traditional medicine treatments under automobile insurance, including ▲establishing related regulations to limit the expansion of single rooms in Korean traditional medicine medical institutions, especially clinics ▲setting appropriate prescription criteria for decoctions ▲establishing and standardizing Korean medical evidence related to indications for pharmacopuncture and Korean traditional physical therapy ▲mandatory issuance of medical certificates for mild patients and setting payment limits according to treatment periods.