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Plans to apply health insurance for major treatments without payment such as spinal magnetic resonance imaging (MRI), echocardiography, and musculoskeletal magnetic resonance imaging have been postponed. It can be interpreted as a “post-storm” caused by the deterioration in health finances due to “Moon Jae-in care (measures to strengthen health insurance coverage)”. In the first half of this year alone, the health insurance budget ran a deficit of over 1 trillion won. Also striking are the growing difficulties in the medical community due to the new coronavirus infection (Corona 19).
▶ Refer to page A12 of November 26
The Ministry of Health and Welfare held the 22nd Health Insurance Policy Ruling Committee (Geonjeongshim) on the 27th and announced the “ National Health Insurance Plan Implementation Plan 2021 ” containing these details.
The plan included the adjustment of reimbursement for spinal magnetic resonance and cardiac ultrasound, which was expected to be implemented in the second half of this year (applying health insurance), to the second half of next year. The Ministry of Health and Welfare recently announced that it will postpone spinal MRI coverage to next year in a meeting with organizations participating in health care, and even echocardiography has been postponed.
The application for health insurance, such as musculoskeletal MRI and ultrasound, which was to be promoted next year as part of the global health insurance plan, has been postponed to 2022.
The government explained that the delay in consultations with the medical community was high. An official from the Ministry of Health and Welfare said: “As the work and management difficulties of medical institutions are increasing due to Corona 19, discussions regarding salaries are stopped.”
However, experts estimated that Moon Jae-in Care’s speed was held back by a sharp increase in the health budget deficit. Moon Jae-in Care is a policy to provide health care to all medical services except beauty and plastic surgery. Huge expenses and consequent fiscal deficits are inevitable. In 2018, the health care fiscal balance recorded a deficit (-1778 billion won) in eight years and last year the size of the deficit increased to 2.82 trillion won.
‘Wuncare’ accelerating after the storm … In the first half alone, the loss was 1.3 yen
The financial situation for health insurance this year is even worse. It is common for health insurance to have a surplus in the first half and a deficit in the second. This is because medical institutions tend to file claims for health benefits in the second half. In the first half of last year, when the annual deficit reached 3 trillion won, a surplus of 88.6 billion won was recorded.
However, in the first half of this year alone, there was a loss of 1,281.4 billion won. This is due to a decline in insurance premiums collected following the worsening of citizens’ income conditions as a result of Corona 19, while the flow of excessive care for new health coverage continued. If the health insurance deficit in the second half of this year is recorded only in the second half of last year (about 2.9 trillion won), the annual deficit will exceed 4 trillion won. It greatly exceeds the original estimate of the deficit (2,727.5 billion won). This is why the government has begun to adjust the pace of expansion of health security guarantees.
The scope of existing payment items is also shrinking. As the financial outlay for the brain MRI test conducted in October last year exceeded the initial estimate by 1.7 times, the benefit was greatly reduced in April. If there were no symptoms, the co-payment rate for MRI treatment had increased from 30 to 60 percent to 80 percent.
The government will also strengthen fiscal consolidation efforts in terms of income. The Ministry of Health and Welfare has determined that “ Expanding government support through revisions such as the Health Insurance Act ” is one of the main tasks of the implementation plan for the global plan for national health insurance 2021. This means that the system will be revised in the direction of increasing the national treasury support rate for health insurance beyond the current 13-14%.
Professor Hong Seok-cheol of Seoul National University’s Department of Economics said, “We need to change the fundamental perception of healthy health and financial strength,” he said. She said.
That day, the Health Insurance Policy Ruling Committee discussed plans to expand health insurance support for burns and injured patients. The Ministry of Health and Welfare decided to apply health insurance starting April next year designating “artificial dermis,” widely used for skin reconstruction treatment of burns and wounds, as an essential benefit. In the case of surgery using two artificial dermis (based on 40-80 ㎠ or less), the cost of treatment materials is now 1.68 million won, but the burden is reduced to 35,000 won after the application of health care. About 90,000 patients will benefit, the Ministry of Health and Welfare has predicted.
Health benefits are also being offered to two new drugs related to osteoporosis and lung cancer. Treatment of osteoporosis of postmenopausal women, “Syringe Ivanitiju Freefield” and treatment of non-small cell lung cancer, “Vizimpro Tablet 15 · 30 · 45mg”. The cost of the new osteoporosis drugs will be reduced from 2.97 million won to 890,000 won and the new lung cancer drugs will decrease from 11.7 million won to 580,000 won.
Seo Reporter Min-joon [email protected]
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