This year, for the first time since the Constitutional Court ruled the medical law provision mandating the reporting of non-reimbursable medical expenses constitutional in February, an investigation into non-reimbursable medical fee information will be conducted. The Health Insurance Review and Assessment Service (HIRA) plans to disclose the results of this investigation in September, earlier than the usual December schedule, to support the public's right to know and rational medical choices. While the government has set plans to expand non-reimbursable reporting to strengthen benefit coverage and reduce medical expenses, civil society and the medical community have expressed mixed reactions.
Non-reimbursable Medical Fees for 565 Items to be Disclosed in September
According to HIRA, the investigation for disclosing non-reimbursable medical costs will begin on the 12th of this month. Medical institutions must submit data on non-reimbursable medical fees and related information through the healthcare institution business portal from the 12th until the 8th of next month. The information disclosure is scheduled to be posted on HIRA’s website and other platforms on September 20.
The non-reimbursable medical fee disclosure system is a system that publicly reveals information on non-reimbursable items operated by hospitals, as designated by the Minister of Health and Welfare. This year, due to benefit conversion and deletions, the number of items has changed from 578 to 565 items (with 863 detailed items). Notably, unlike last year when the disclosure was made on December 14, this year the schedule has been moved up to September.
HIRA’s disclosure of non-reimbursable information is characterized by its high level of detail. When searching hospitals by city, county, or district, the non-reimbursable price information for specific items at the medical institution appears. Since price information compared to medical institutions of the same scale in the area is also provided, it can guide medical consumers to make rational choices. The disclosed non-reimbursable items are subdivided into categories such as superior hospital room fees, education and counseling fees, examination fees, magnetic resonance imaging (MRI), vision correction surgery fees, hair transplantation fees, physical therapy, injection fees, and more, allowing for comparative selection.
Park Hye-jung, Director of the Benefit Strategy Office at HIRA, said regarding this non-reimbursable investigation, "We will simplify data entry by utilizing information submitted in the previous year and provide remote support to institutions that have difficulty submitting data, so that medical institutions can conveniently submit data. We ask for active cooperation from medical institutions."
"Non-reimbursable Reporting Items Should be Expanded" vs. "It Will Lead to Non-reimbursable Control"
On February 23, the Constitutional Court ruled that the medical law provision requiring medical institutions to disclose non-reimbursable medical fees and details does not violate the constitution in a constitutional complaint trial. However, with a close decision of 5 justices in favor (constitutional) and 4 against (dissenting), the medical community regarded it as a narrow constitutional decision. The Korean Medical Association emphasized the minority opinion of the justices and expressed concerns that the non-reimbursable reporting system demands sensitive medical information. The association stated, "If the purpose of the non-reimbursable medical fee reporting and disclosure system is to guarantee the public’s right to know and medical choice, the target should be limited to items and amounts. We are skeptical about why extremely private basic information such as patient gender and birth year, as well as sensitive medical information such as diseases, treatment details, and medications, are necessary. Ultimately, this appears to be an intention to control non-reimbursable fees and aggregate citizens’ medical information."
Conversely, civil society voices are strong in favor of expanding non-reimbursable reporting. The Citizens’ Coalition for Economic Justice (CCEJ) stated, "Non-reimbursable items are medical services for which medical institutions independently set prices and frequency, and they are a key factor causing excessive treatment and excessive medical expenses for patients." They urged the government to enhance the effectiveness of the system by mandating reporting of all non-reimbursable items, expanding reporting periods and frequencies, and compulsory disclosure of the list of medical institutions that fail to report. The National Health Insurance Labor Union also evaluated, "Non-reimbursable medical services occur extensively due to the absence of standardized medical fees, uncertain safety, and use as a means of profit generation, but there is no system to properly manage and supervise them. The non-reimbursable reporting system will be a starting point to address these issues."
Meanwhile, the government is promoting strengthening appropriate management of non-reimbursable services as part of health insurance reform. In 2024, the reporting target will include major non-reimbursable items estimated to account for about 90% of the total non-reimbursable scale, including the currently disclosed items. These non-reimbursable items encompass approximately 100 pharmaceutical items, 436 therapeutic non-reimbursable items, as well as nutritional injections, vaccinations, dental orthodontics, and herbal medicine, totaling 1,212 items.
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