Jeong Giseok, Director of the National Health Insurance Service, Outlines Key Tasks for This Year
"Worries Over Deficit If 2 Trillion Won Is Invested Annually in Essential Medical Services"
Information on Non-Covered Services to Be Disclosed on the 'Non-Covered Service Information Portal' for Rational Medical Use
The National Health Insurance Service (NHIS) has decided to strengthen its benefit management functions by analyzing the benefit claims submitted by each hospital to verify whether the public (insured individuals) are receiving appropriate treatment and to address excessive medical care or prescriptions. Despite the ongoing emergency medical system for a year, the health insurance finances have continued to run a surplus. Although benefit expenditures are expected to remain generally stable this year, it is anticipated that the finances will turn to a deficit if the government’s plan to invest 10 trillion won over the next five years in essential medical services is implemented.
On the site of the Ilsan Hospital in Goyang City, Gyeonggi Province, where a hospital had been planned, construction of a children’s hospital is set to begin with the goal of opening in 2028. This hospital will be responsible for pediatric emergency care and follow-up treatment in the northern Gyeonggi region.
Jung Ki-seok, President of the National Health Insurance Service, held a press briefing on the 20th at the Yeongdeungpo Northern Branch Office in Yeouido, Seoul, explaining the service's operational plans for this year. Photo by National Health Insurance Service
On the 20th, Jeong Gi-seok, Director of the National Health Insurance Service, held a press conference at the Yeongdeungpo Northern Branch Office in Yeouido, Seoul, stating, "We will strengthen income and expenditure management to maintain the soundness of health insurance finances."
The NHIS plans to first secure government subsidies at a stable level of about 12.6 trillion won this year and strengthen premium collection management, while encouraging appropriate medical care through benefit analysis. In particular, for benefits that meet the criteria but are analyzed as abnormal items, the NHIS will guide insured individuals to file objections and request the Health Insurance Review and Assessment Service to strengthen its reviews.
Director Jeong pointed out, "Through objections raised by some insured individuals, it was confirmed that medical institutions conducted tests or treatments that were unnecessary." He cited an example where an emergency room patient who tested positive for influenza underwent as many as 59 tests, including for AIDS, rheumatoid arthritis, thyroid disease, and hepatitis. This patient’s medical expenses were four times higher than the average for other influenza patients visiting the emergency room, and half of the cost was paid out-of-pocket.
To support the public’s rational use of medical services, the NHIS will also strengthen management of non-covered services. Director Jeong said, "We will solidify the operation of the non-covered service reporting system, accurately grasp the actual situation, and establish a systematic management foundation through monitoring. We will disclose comprehensive information on non-covered medical services via the ‘Non-Covered Service Information Portal’." He added, "In consultation with the government, we will also promote converting medically necessary treatments into health insurance benefits."
Although health insurance finances have recorded surpluses for four consecutive years, the ongoing emergency medical system due to conflicts between the medical community and the government means the situation cannot be taken lightly. Last year, as treatments at tertiary hospitals decreased, benefit expenditures also declined, resulting in a surplus of about 1.7 trillion won for the NHIS.
Director Jeong said, "While the conflict between the medical community and the government may continue for some time, if benefit expenditures for tertiary hospitals do not increase significantly, the expenditure side should be manageable. However, if the government’s plan to invest 10 trillion won over five years, or 2 trillion won annually, in essential medical services is implemented, the finances will turn to a deficit." He added, "Since it will take time to develop and implement specific measures, the NHIS will also create financial operation plans accordingly."
Additionally, the NHIS plans to begin construction as early as next month on a building with four underground floors and six aboveground floors near Ilsan Hospital to establish a children’s hospital equipped with comprehensive functions from emergency care to rehabilitation. Approximately 13 pediatric specialists will be newly hired to make the Ilsan Children’s Hospital a ‘Mecca of Pediatric Diseases,’ and in case of emergencies, it will be converted into an infectious disease specialized hospital.
Director Jeong said, "Seeing the recent crisis in pediatric care, I thought a children’s hospital was necessary, but considering profitability, it was judged that establishment by the private sector would be difficult. Therefore, this decision was made." He added, "We will establish a regionally complete pediatric care system that can cover emergency and follow-up care in the northern Gyeonggi region."
Regarding the tobacco lawsuit that has been ongoing for over ten years, he expressed determination to pursue the case to the end for a historic ruling, saying, "We will proceed with the appeal and, if necessary, go to the Supreme Court, keeping only the public’s health in mind." Director Jeong, who plans to personally argue the case at the 12th trial in April following the 11th trial last month, emphasized, "Hundreds of deaths occur daily worldwide due to tobacco. We will do our best to persuade the court."
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