High Non-Covered Service Rate in 'Mixed Treatment'... Increasing Patient Medical Expense Burden

Household Burden of Medical Expenses in Gyeongsang 28%... Among Top OECD Countries
Residents Also Concentrate in Specialties with Many Non-Covered Treatments

Household direct payments, including out-of-pocket expenses for non-covered medical services not covered by health insurance, accounted for nearly 30% of total current medical expenditures. Critics point to so-called 'mixed treatment,' which inserts non-covered items into covered items, as the cause.

According to the Ministry of Health and Welfare's National Health Accounts on the 4th, domestic current medical expenditures in 2022 amounted to 209.0463 trillion KRW, an increase of 126.5% from 92.3109 trillion KRW in 2013. During this period, it increased annually by at least 6% and up to nearly 10%.

Current medical expenditures refer to the final consumption expenditure spent by the entire population of a country on health care goods and services in one year. It is largely composed of government and mandatory insurance (health, industrial accident, long-term care, automobile liability insurance) medical expenses and private medical expenses.

Among Korea's private medical expenses, household direct payments accounted for 28.04% of total current medical expenditures as of 2022. This significantly exceeds the OECD average of around 20%.

In particular, the amount borne by households for non-covered services not covered by health insurance (non-covered expenses) is also rapidly increasing. Non-covered out-of-pocket expenses rose from 17.7129 trillion KRW in 2013, surpassing 30 trillion KRW in 2021, and further increased to 32.3213 trillion KRW the following year.

Since non-covered treatments are autonomously priced by hospitals and are not subject to price controls, they are easy to generate profits but, conversely, are identified as a factor that increases patients' medical expenses burden.

[Image source=Pixabay]

This increase in non-covered costs is pointed out to be due to mixed treatment medical services that combine health insurance covered items with non-covered items. For example, performing non-covered multifocal lens surgery during cataract surgery or inducing manual therapy while receiving covered physical therapy.

There are also many criticisms that doctors leaving clinics for non-covered treatments have led to the collapse of essential medical services. The higher the income of a doctor's specialty, the higher the competition rate for residents, and it is analyzed that doctors in specialties with high non-covered rates have relatively higher incomes.

According to data released on the 4th by the Policy Research Institute of the National Health Insurance Labor Union, among all specialists in 2020, ophthalmology had the highest annual income at 389.18 million KRW, followed by orthopedics, neurosurgery, dermatology, rehabilitation medicine, anesthesiology and pain medicine, and radiology. The non-covered rate was highest in rehabilitation medicine at 42.6%, followed by ophthalmology at 42.3%, and orthopedics at 36%.

Among these, five specialties were included in the top seven specialties by resident application rates. Ophthalmology, ranked first in income, also had the highest resident competition rate at 1.75 to 1 that year. In contrast, pediatric specialists had the lowest income at 134.74 million KRW annually, and not only did they fail to fill their resident quotas, but their competition rate was also among the lowest.

In response, the government plans to invest more than 10 trillion KRW by 2028 to intensively raise fees for essential medical services and to resolve distortions in the medical system and compensation imbalances in the non-covered market by banning mixed treatment. If non-covered items such as manual therapy for non-severe conditions are combined with covered items, health insurance claims will be blocked.

The government plans to establish a Medical Reform Special Committee directly under the president to prepare detailed measures for banning mixed treatment.