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Health insurance’s reimbursement rate averages at 85%
  • By Constance Williams
  • Published 2017.10.24 18:32
  • Updated 2017.10.24 18:32
  • comments 0

Preparing a plan for proper compensation is imperative because the health insurance’s reimbursement rate of healthcare cost remains at about 85 percent – and 106 percent even if non-payment items are included -- a lawmaker said Tuesday.

Rep. Nam In-soon남인순 of the ruling Democratic Party said so while releasing the data submitted by the Health Insurance Review & Assessment Service (HIRA) on reimbursement costs for six types of insurance-covered treatment.

"As a result of conducting an accounting survey on medical institutions for the second reorganization of the relative value, the average rate of compensation for the six types of medical care was 85 percent, and 106 percent when non –payment is included,” Nam said.

The reimbursement costs of the six types were 75 percent for primary care, 76 percent for surgery, 85 percent for treatment, 74 percent for functional tests, 159 percent of sample tests, and 122 percent for imaging tests.

"After the introduction of the concept of relative value in 2001, HIRA reorganized its relative value score by announcing the financial investigation of medical institutions to improve relative value by type in 2012,” Nam said.

She went on to say, “In the past five years, we announced the results of accounting audits of medical institutions to improve relative value by type and revised the second relative value point. And the cost of surgery, treatment, and functional costs increased to 90 percent, while the sample and screening costs were kept at 142 percent and 116 percent, respectively.”

Nam also pointed out that Korea's medical industry is considered one of the best in the world, but the level of cost compensation is insufficient.

"The debate over the ‘Moon Jae-in care’ has led to a shift in the health insurance system of Korea from low-cost-low-burden-low-wage system to optimal-cost-optimal-burden-optimal-wage system," the lawmaker said. "To properly compensate the right burdens, it is necessary to prevent the leakage of the insurance funds raised by the people's premiums and to have a social consensus on the appropriate number.”

The premiums and benefits are set by the Health Insurance Policy Deliberation Committee, but there is not much discussion about the appropriate number based on cost, Nam added.

"To determine the appropriate level, a large number of model hospitals or cooperative hospitals are needed for each region,” Nam said. "It is necessary to set up special committees to discuss the compensation system and actively review measures for social consensus process.”


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