NHIS head calls for curbing overuse of medical services, excessive tests

National Health Insurance Service (NHIS) President Jung Ki-suck emphasized that excessive medical use by patients and undue tests by medical institutions should be sanctioned more strongly to stabilize the state health insurance system.

Jung made these and other points at a Thursday meeting with journalists covering the agency, explaining the overall health insurance policy.

At the meeting, Jung stressed the need to strengthen the application of higher out-of-pocket expenses for excessive healthcare users who use outpatient services 365 days or more a year.

“There are about 2,500 patients who use outpatient care for 365 days or more a year, which is not large in number. However, their health insurance benefits are more than 15 times higher than the average patient's,” Jung said. “If we compare the health insurance finance to a well, these excessive users drink 15 cups of water and even wash their face with the remaining water while most others drink just one cup.”

“We have to go together with patients who are sick and have no choice but to use outpatient care, but must enhance co-payments for (unnecessary) use of medical services,” Jung added.

The NHIS head also noted that medical institutions’ practices, including excessive testing, must be improved.

“When a patient is hospitalized, blood is drawn once a day for tests, and X-rays are taken every morning. In some extreme cases, CT scans are taken more than 10 times from hospitalization to discharge,” Jung said. “We are thinking about whether this is right from the perspective of managing finances.”

“Novice doctors don't know many things and have many questions so that they can find a solution through tests, but I think it is excessive for experienced doctors to practice this way,” he said. “However, it is also problematic that the healthcare authorities regard the treatment by a first-year doctor and a 30-year veteran doctor as the same.”

Korea has a strange structure where doctors make money if they do a lot of tests because they don't know much about it, Jung pointed out, adding that this is something that needs to be corrected in terms of fiscal consolidation.

However, the NHIS head stressed that aside from fiscal consolidation efforts, current financial management is stable. Based on this, he said, the recovery of health insurance payments made to medical institutions under the emergency treatment system could be postponed.

“It's not a final decision yet, but we're going to postpone the retrieval of advance payments to medical institutions instead of collecting them in January next year (as originally planned),” Jung said. “We don't have any major financial problems, and we can afford it. However, unlike during Covid-19, if there is an abnormal situation (such as a medical institution going out of business), we will recover immediately through securing receivables.”

Besides financial management, Jung expressed his position on various health insurance policies.

For example, he said it was excessive to require students to take chest X-rays to detect tuberculosis (TB) in the national health examination.

“The national health examination is a system that we can be proud of regarding the early detection and awareness of diseases,” Jung said. “However, we must find an efficient way of screening. For example, I don't think taking a chest X-ray for the early detection of TB in student screening is necessary.”

Jung noted that it can be detected if a cough lasts more than two weeks and the patient goes to a healthcare provider for a chest X-ray. Still, it is not medically appropriate to screen all children. He explained that the NHIS discusses it with the Ministry of Health and Welfare and the Korea Disease Control and Prevention Agency to improve the matter,

Jung vowed to introduce a special judicial police officer system, one of the NHIS's biggest aspirations, within his term.

“I would like to have the system in place by the end of my term,” Jung said. “Medical organizations are not opposed to it, except for the Korean Medical Association. I think it (the introduction of the system) is also a way to realize a just society.”

“Some say that the investigation period (of hospitals run by people who are not physicians) is long at about 11 months. It tends to be long because it is investigated by the police, not by experts. If the NHIS operates quasi-judicial investigators, it will be possible to shorten the probes by utilizing their expertise.”