The government should introduce a coercive system to curb the rapid increase in medical costs for senior citizens by, for instance, restraining their hospitalization, a state agency said.
In the longer run, local communities ought to play a pivotal role in integrating their management, it added.
National Health Insurance Service국민건강보험공단(NHIS) made these and other points in a recent report titled “Measures to manage medical cost for elderly people more effectively to prepare for the aged society.”
The agency conducted the study to work out short-, mid- and long-term steps to manage healthcare costs for the elderly population. The report not only deals with the problems of the present system but also a more desirable role the health insurance service should play.
According to the report, Korea is aging most rapidly in the world to enter into an aged society in 2018 with people 65 or older account for 14 percent of the nation’s population. In 2025, this country will likely become a superaged society with the equivalent ratio exceeding 20 percent.
In the short run, the report called for controlling the use of medical services by elderly citizens through reexamining the flat rate payment system for elderly outpatients and reducing the days of hospital treatment and hospital beds for old people.
Introduced to help people aged over 65 ease their medical cost burden, the flat rate payment system allows them to pay only 1,500 won ($1.33) if their total treatment cost does not exceed 15,000 won ($13.3), and calls for them to shoulder 30 percent of bills if total expense exceeds 15,000 won. The report, however, calls for readjusting upward the coinsurance rate of the seniors to curb their excessive use of healthcare services.
The study also proposed to obligate prior screening of the appropriateness of hospitalization to reduce unnecessary hospital treatment. Health Insurance Review and Assessment Service건강보험심사평가원 (HIRA) should play the central role in judging the propriety of admission, while NHIS ought to take responsibility for public relations activities.
The report also called for restricting days of hospital treatment by adopting the grading system of hospitalizing period for the effective management of re-hospitalizing patients with chronic diseases as well as reducing acute phase hospital beds to reduce hospitalization fundamentally, as is the case in Japan.
Hospitals will need to make a functional approach, in which even large hospitals should lower hospital bills for recovering patients and smaller hospitals can raise bills for patients in an acute phase, the report said. In doing so, medical institutions should divide hospital beds into highly acute beds, acute care beds, and recovery beds as well as differentiate the assignment of nurses according to the beds’ function, it added.
Particularly, the report pointed out that it is crucial to curb the surging use of nursing hospitals and improve their services. It stressed the need to prevent unnecessarily long hospitalization by toughening hospitalizing criteria. More specifically, it proposed to mix flat rate payment and free-for-service system in proper ways, providing appropriate medical services and linking the service quality to medical bills.
The report also pointed to the need to prevent the abuse of the practice that treats new medical technologies on the waiting list for insurance coverage as legally uninsured items. It presented some alternatives to it, including the introduction of doctors for seniors, Personal Health Record (PHR), and healthcare point system.
Also needed is establishing integrated services by linking the long-term care insurance for the aged to the health insurance system. NHIS is now operating both insurances, but there are problems, including the blind spots of services, overlapping services, and quality levels, because of different laws applied to the two insurances as well as the difference of organization between NHIS and the Ministry of Health and Welfare. Even the division of roles is vague between nursing hospitals and nursing homes.
Accordingly, the researchers said the government should reduce medical costs by supplementing healthcare services at nursing facilities. Also, it should be able to integrate their management by setting up strategies to link health insurance’s medical services to long-term care insurance’s caring services for the elderly with chronic diseases.
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