Researcher proposes ways to reform health insurance amid 4th industrial revolution

Korea needs to introduce “medical fee charging system for artificial intelligence-aided diagnosis” as one way to readjust the role of health insurance in the fourth industrial revolution era, a researcher proposed Thursday.

If hospitals reduce fees for doctors and introduce charging system for AI’s reading of various data with certain levels of ensured accuracy, the medical institutions will introduce more products related to fourth industrial revolution, like Watson, he explained.

Shin Young-seok신영석, a researcher at Korea Institute for Health and Social Affairs한국보건사회연구원(KIHASA), made these and other points at an academic conference, organized by Korean Academy of Health Policy and Management한국보건행정학회(KAHPM), while making a presentation with the title of “future of medical insurance to cope with the fourth industrial revolution.”

Korean Academy of Health Policy and Management holds an academic conference to commemorate the 40th anniversary of introducing medical insurance system, at a hotel in Wonju, Gangwon Province, Thursday.

Shin presented a set of principles to reform medical insurance amid fourth industrial revolution, which, among others, call for enhancing public interests and convenience, upgrading safety and quality of healthcare service, ensuring a balance between the protection of personal information and realizing public purposes, and preventing medical divide.

Particularly, he mentioned the need to introduce medical fee charging system for AI’s data reading, as one way of promoting private industry for the sake of enhancing public interests and convenience and realizing that goal.

“If the industry lowers fees for doctors and charges fees for AI’s reading of medical data (provided it ensures a certain level of accuracy or higher), it will be able to speed up the introduction of new products by medical institutions,” Shin said. “The United States approves charging of fees for additional image interpretation by doctors who conduct mammography at diagnostic radiology division with computer-aided supplementary programs.”

Shin also called for the government to remove restrictions based on a private information protection law to develop the medical insurance system in the fourth industrial revolution.

“Intelligence production is crucial in the fourth industrial revolution era. The government has to allow the health insurance to participate in producing information to let them take the lead in the industry’s growth,” he said. “The government should give incentives to participants and collect intelligence. And such an incentive should come from health insurance.”

Professor Yoon Seok-jun윤석준 at Korea University College of Medicine고려대 의과대학 also said the government should support health insurance to reinvigorate research and development that can help the industry cope with fourth industrial revolution.

“A contact point is necessary to serve as a bridge between medical technology, R&D, and health insurance. Revitalization of R&D is needed to prepare for the fourth industrial revolution,” Prof. Yoon said. Yoon presented some ways to improve system for reinvigorating R&D, such as allowing the setup of technology holding companies for R&D within the extent of hospitals’ auxiliary businesses, expanding value assessment-based compensation for medical acts and treatment materials, enhancing the application of health insurance for clinical trials for the sake of public good, and making it mandatory for health insurance-covered consulting from the early state of R&D.

Noh Hong-in노홍인, director general of the Bureau of Health Insurance Policy at the Ministry of Health and Welfare보건복지부(MOHW), said the ministry would faithfully reflect changes resulting from fourth industrial revolution for the development of health insurance.

“There is not a comprehensive plan to develop the medical insurance system, but we should work out one because the law was modified in this direction last year,” Noh said. “We will take pains to find out how the fourth industrial revolution can contribute to the medical insurance, and figure out how the ministry can support it.”

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