The Financial Supervisory Service (FSS) and the National Health Insurance Service (NHIS) have joined forces to curb rising private health insurance premiums and the depletion of national health insurance funds caused by excessive non-reimbursable medical treatments.
The two organizations announced on Tuesday (June 30) that they have signed a memorandum of understanding (MOU) aimed at the proper management of non-reimbursable medical expenses and the establishment of rational roles for public and private medical insurance systems.
Until now, the structure of non-reimbursable treatments—where supply and demand are determined by price—has led to repeated instances of over-treatment, particularly in specific areas, due to the 1st to 4th generation private health insurance systems that cover 70 to 100 percent of non-reimbursable medical costs.
A typical example of such over-treatment is when patients receive physical therapy, which is a covered benefit, alongside non-reimbursable treatments like manual therapy or extracorporeal shockwave therapy.
It has been pointed out that this practice has negatively affected the overall medical system by triggering hikes in private health insurance premiums, causing leaks in national health insurance finances, and leading to a concentration of non-reimbursable medical services.
In fact, insurance payouts for the top 10 non-reimbursable treatments, including manual therapy, accounted for approximately half of all non-reimbursable insurance claims.
In response, the FSS has been pushing for reforms in private health insurance, while health authorities have been strengthening the management of non-reimbursable expenses as part of a pan-government effort.
Through this agreement, the two agencies have decided to establish a "public-private medical insurance cooperative non-reimbursable monitoring system" based on the implementation of managed benefits and voluntary corrections by the medical community.
In particular, they plan to share private health insurance data regarding manual therapy and extracorporeal shockwave therapy to intensively monitor treatment prices and usage volumes, and to evaluate the effectiveness of non-reimbursable expense management.
Furthermore, the agencies will conduct joint research and pursue institutional improvements regarding the relationship between national health insurance and private health insurance. The FSS has also agreed to actively provide private insurance data when the NHIS conducts inspections into financial leaks within the public and private medical insurance systems.
(Photo: Yonhap News)
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