Following the initial pilot project for herb medicine reimbursement, a mere 33.2 percent of participating organizations prescribed the medicine, leading to a financial execution rate of only 3.9 percent.
However, according to health officials, the government will push ahead with the second pilot project from April 2024 to December 2026.
On Wednesday, the Ministry of Health and Welfare reported on the “Performance Evaluation of the Pilot Project for the Application of Health Insurance to Herb Medicine” to the Health Insurance Policy Deliberation Committee.
The pilot project, which began on November 20, 2020, was conducted for patients aged 65 or older with cerebrovascular disease sequelae, facial nerve palsy, and dysmenorrhea treated by oriental medical clinics that applied for the project and were approved by the minister of health and welfare.
Patients were prescribed herbal medicines at outpatient oriental clinics as health insurance subscribers or their dependents. The activities related to herbal medicines were differentiated into two categories – distinguishing- prevention and dispensing-decoction -- and the price ceiling of herbal medicines was set for each disease.
The out-of-pocket payment rate was 50 percent, and each patient could prescribe up to 10 days of herbal medicines per year.
According to the ministry, 9,025 oriental clinics participated in the project, accounting for 61.9 percent of the total 14,557. Herbal medicines were prescribed by 2,992 clinics, or 33.2 percent of the selected clinics. About 45,000 patients participated in the pilot project, and about 91,000 prescriptions were issued.
By targeted disease, the largest share of 71.1 percent of the patients had dysmenorrhea, followed by 22.9 percent with facial nerve palsy and 6.0 percent with cerebrovascular disease sequelae. The number of prescriptions was also 76.5 percent for dysmenorrhea, 18.8 percent for facial nerve palsy, and 4.7 percent for sequelae of cerebrovascular disease.
In the patient satisfaction survey, 95.6 percent of the surveyed were satisfied with the pilot program, and 93.9 percent and 90.2 percent of oriental medicine practitioners said they would continue to participate if the pilot program continues.
In terms of the execution rate compared to the financial estimates, because of the low participation in the pilot project, only 4.51 billion won ($3.36 million), or 3.9 percent of insurer contribution (161.1 billion won -153.1 billion won), projected in July 2020, was estimated to have been executed.
The ministry also reported the results of the safety and efficacy analysis of herbal medicines, saying that there were no statistically significant changes in liver function indicators and kidney function indicators before and after taking herbal medicines, quoting “Safety Study on Herbal Medicine Dispensed by Oriental Medical Institutions” by Daegu Haany University.
Using health insurance claims data for each of the three diseases, the ministry also compared the group of patients participating in the pilot project with the group of patients receiving Western medical care, finding that it was difficult to determine whether taking dispensed herbal medicines under the pilot project had an impact on liver and kidney function impairment compared to the medical care group.
Regarding cost-effectiveness, patients who participated in the pilot project perceived a cost savings of 84,860 won when prescribing health insurance herbal medicines compared to non-reimbursed herbal medicines.
Based on these results, the ministry said it is necessary to promote the project after continuously reviewing the appropriateness of inclusion in the suppository health insurance system by improving the business model and extending the project.
To this end, it added lumbar disc herniation, allergic rhinitis, and functional dyspepsia to the target diseases. It expanded the target institutions to include oriental hospitals other than oriental clinics and hospitals that operate oriental medicine courses.
It has also adjusted fees to reflect the new “3D pulse imaging test' in August 2021, after the pilot project was implemented, and the fee for in-depth anti-mutagenesis technology will be adjusted from 35,500 won to 45,510 won.
It has adjusted ceilings from 41,450 won to 74,450 won per disease by updating the unit price of each drug.
The ministry will also expand the benefits standard to two prescriptions of a 10-day supply of herbal medicines for two diseases per patient per year and relax the standard to a maximum of eight claims per day, 60 claims per month, and 600 claims per year for one practitioner.
The patient's co-payment rate will be changed from the current 50 percent to the institution's statutory co-payment rate.
The ministry estimated that the extension of the pilot project will cost an average of about 64.7 billion won per year. It plans to prepare for the launch of the second phase of the pilot project from February to March 2024 and implement the second phase of the pilot project from April to December 2026.