Insurance Research Institute "Management of Non-reimbursed Actual Loss Should Continue"
Non-reimbursed treatments such as manual therapy have been identified as a cause of leakage in indemnity insurance claims, and it has been found that non-reimbursed expenses are relatively well managed in the 4th generation indemnity insurance. However, since some over-treatment has been observed in Seoul, there is an analysis that continued management of non-reimbursed treatments to suppress over-treatment is necessary.
The Korea Insurance Research Institute announced on the 24th through the report titled "Status of Non-Reimbursed Treatments in 4th Generation Indemnity Medical Insurance" that "the proportion of non-reimbursed expenses in sprain and strain treatments is lower in the 4th generation indemnity insurance compared to the 1st to 3rd generations, indicating that non-reimbursed treatments are somewhat managed," but also noted that "over-treatment is observed in some regions." Sprains and strains, commonly referred to as being "twisted," can be prescribed treatments such as manual therapy.
The ratio of non-reimbursed expenses to total medical expenses for sprain and strain treatments under the 4th generation indemnity insurance was 48.9%, which was lower than that of other generations. In the 2nd generation indemnity insurance and group indemnity insurance, which have higher ratios of non-reimbursed expenses relative to medical expenses, the proportions were recorded at 52.8% and 53.4%, respectively.
The proportion of rehabilitation physical therapy, which also has a high share of non-reimbursed treatments, was found to be lowest in the 4th generation indemnity insurance. The 4th generation indemnity insurance recorded a rehabilitation physical therapy proportion of 33.5%, whereas the 1st and 2nd generation indemnity insurances and group indemnity insurance recorded 35.7% and 38.3%, respectively.
However, the Korea Insurance Research Institute explained that over-treatment occurs when 4th generation indemnity insurance subscribers receive treatment in Seoul. An analysis of the median medical expenses for the 4th generation indemnity insurance showed that Seoul had the highest median cost at 264,000 KRW. Gyeonggi (234,000 KRW) and non-metropolitan areas (225,000 KRW) were found to have medical expenses approximately 30,000 to 40,000 KRW lower than Seoul.
Jeon Yong-sik, Senior Research Fellow at the Korea Insurance Research Institute, stated, "Since the 4th generation indemnity insurance was introduced with the goal of managing non-reimbursed treatments, the fact that the 4th generation has a lower proportion of non-reimbursed expenses than previous generations means that the purpose has been achieved to some extent. However, upon closer examination, some over-treatment has been observed, indicating that management of non-reimbursed treatments is still necessary."
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