Starting next year, the out-of-pocket rate of medical expenses for so-called “medical shopping” patients who visit hospitals more than 300 times a year is expected to increase to 90%. The standard, which had to be applied more than 365 times a year, will be strengthened.
The Ministry of Health and Welfare announced on Tuesday that it has announced legislation to revise the Enforcement Decree of the National Health Insurance Act. Currently, if a patient receives outpatient treatment more than 365 times a year, the patient himself/herself bears 90 percent of the medical expenses for the excess medical treatment. However, this standard will be lowered to 300 times. Considering that the out-of-pocket rate for outpatient treatment is 30 percent to 60 percent (senior general hospital), the burden of medical expenses for patients who visit hospitals every day will increase significantly.
This is a measure to reduce excessive medical use and prevent the deterioration of health insurance finances. As of 2024, the number of patients exceeding 300 outpatient treatments was counted as 8,460. The health insurance budget for these medical expenses amounts to about 81 billion won. Many are patients who receive physical therapy or receive injections. However, patients with unavoidable reasons may be recognized as exceptions. The regulation to strengthen the number of outpatient treatments will take effect from January 1 next year.
The government plans to establish and operate a system to check the details of medical benefits in order to understand the current status of such medical use in real time. The Health Insurance Review and Assessment Service will operate the system.
A system will also be implemented to ease the burden on office workers to pay health insurance premiums. The deadline for businesses to notify the National Health Insurance Service of subscribers’ salary information in connection with the annual year-end tax settlement for employees in April will be extended by three weeks from March 10 to March 31. Efficiency of business processing was considered.
This settlement will also ease the standard for installment payment for additional insurance premiums. Previously, installment payments were possible only when the additional insurance premium to be paid exceeded the premium for the month. However, the amendment lowered this to the level of the lower limit of monthly insurance premiums. As a result, it is expected that more office workers will be able to pay out additional insurance premiums without paying them at once. Regulations related to insurance premiums will take effect immediately after the bill is promulgated.
The Ministry of Health and Welfare said it will collect public opinions on the amendment by May 4.
JULIE KIM
US ASIA JOURNAL
