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37 Million People Benefiting from Reduced Healthcare Expenses worth KRW 9.2 Trillion

  • Date : 2021-08-13
  • Hit : 888

37 Million People Benefiting from Reduced Healthcare Expenses worth KRW 9.2 Trillion

- The outcomes of the National Health Insurance protection reinforcement initiative over the past four years are announced -

□ The Ministry of Health and Welfare (Minister Kwon Deok-chul) and National Health Insurance Service (President Kim Yong-ik) announced on August 12 (Thu.) the major outcomes of the National Health Insurance protection reinforcement initiative in commemoration of the fourth anniversary of its implementation.

○ In August 2017, the Ministry of Health and Welfare launched the National Health Insurance (NHI) protection reinforcement initiative (hereinafter referred to as the “Initiative”) under the aim of expanding the coverage of NHI to include medically required non-benefit items (previously paid entirely by the insured) in the list of items subject to healthcare benefits (covered by NHI) and thereby dramatically reducing the healthcare expense burden of vulnerable groups (children, women, low-income households, etc.) to move forward towards realizing a country free from worries about healthcare expenses.

○ The Initiative, which focuses on the three areas of “the inclusion of non-benefit items in the list of items subject to healthcare benefits”, “the easing of the healthcare expense burden of vulnerable groups”, and “the enhancement of the healthcare safety net”, shall remain in operation until 2022.

□ The latest developments in the three areas are as follows.

○ For the inclusion of non-benefit items in the list of items subject to healthcare benefits, we prioritized non-benefit items and severe diseases, which are more costly to treat and thus require protection more critically .

- In order to resolve the issues and healthcare expense burden generated by the so-called “top 3 non-benefit items” (physician designation surcharges, non-standard hospital room charges, and caregiver charges), we abolished the physician designation surcharges, included two-person and three-person rooms at healthcare providers of hospital level or higher in the coverage, and more than doubled the number of beds subject to integrated careviging and nursing services (26,381 beds in 2017 → 60,287 beds in 2021).

- NHI was also applied to non-benefit items required for treatment, such as sonograms and MRI testing, in a phased manner to lessen the healthcare expense burden of the public.

- As a result, the NHI protection rate at upper-level general hospitals rose from 65.1% in 2017 to 69.5% in 2019, and that at general hospitals rose from 63.8% in 2017 to 66.7% in 2019.

○ We expanded the protection coverage for vulnerable groups such as children, seniors, people with disabilities, and women to reduce their co-payments.

- The co-payment rate (percentage of healthcare expenses assumed by patients) for hospitalization treatment expenses for children aged 15 and younger was reduced (10-20% → 5%), while the co-payment rate for outpatient treatment expenses for those under 1 was also adjusted downwards (21-42% → 5-20%). The co-payment rate for outpatient treatment expenses for premature babies and infants with low birth weight was reduced to 10% for those under 36 months and 5% for those under 60 months. In addition to cavity treatment, orthodontics procedures for cleft lip and palate treatment is now covered through NHI, reducing the burden of related expenses from KRW 35 million to KRW 7.3 million.
- For seniors, the co-payment rates for advanced-stage dementia treatment (20-60% → 10%) and dentures and dental implants (50% → 30%) were adjusted downwards.

- For people with disabilities, we expanded the eligibility for benefits in relation to assistive devices* and increased the coverage amounts for artificial limbs (by 22.8% on average).
*Decubitus ulcer prevention cushion: Previously for patients with physical disabilities only → Patients with physical disabilities and with brain disordersPortable power lift: Previously for patients with brain disorders only → Patients with brain disorders and physical disabilities

- We took measures to provide necessary support to help resolve the low birth rate, such as applying NHI to infertility treatment for women.

- As a result, the NHI protection rate for those aged 5 and younger rose from 66.8% in 2017 to 69.4% in 2019, and that for those aged 65 and older from 68.8% in 2017 to 70.7% in 2019.

○ To reinforce the healthcare safety net, the ceiling for the co-payment amount assumed by those in the lower 50% income bracket on an annual basis* was set at 10% of annual income**, thereby expanding healthcare expense refunds for low-income households.
* The co-payment amount exceeding the ceiling is refunded.
** KRW 1.22 million → KRW 800,000 for those in the lower 10% income bracket / KRW 1.53 million → KRW 1 million for those in the lower 20-30% income bracket / KRW 2.05 million → KRW 1.5 million for those in the lower 40-50% income bracket

- The diseases eligible for the catastrophic healthcare expense support project, designed to support non-covered items required for treatment, were expanded to all diseases from the four severe diseases* covered in the past, with the aid ceiling raised from KRW 20 million to KRW 30 million.
*Cancer, heart diseases, brain diseases, and rare incurable diseases

□ As a result of the implementation of the Initiative, a total of 37 million people benefited from the reduction of healthcare expenses worth KRW 9.2 trillion from 2018 to 2020.

○ In particular, it was evaluated that healthcare expense support was clearly recognized in the cases of the recipients of infertility treatment (KRW 1.92 million on average for 270,000), pediatric cavity treatment (KRW 150,000 on average for 1.24 million), and advanced-stage dementia treatment (KRW 690,000 on average for 60,000).

○ The percentage of those with positive responses to the Initiative dramatically rose from 39.7% at the time of its announcement to 94%* in August 2020.
*Surveys conducted by Korea Research International commissioned by NHIS.

□ NHI has successfully served as a reliable foundation in combating the pandemic by providing KRW 1.1 trillion as of June.

○ We provided support to ensure effective on-site application of infection control and prevention measures by widening the range of medical fees covered in relation to the prevention, diagnosis, and treatment of the pandemic.

- To curb the spread of the pandemic and ensure treatment in isolation for COVID-19 patients, we provided hospital isolation room expenses, expenses for patient care at residential treatment centers, etc., while also covering infection control and prevention expenses for sanatoriums and other vulnerable institutions.

- To help healthcare institutions identify and diagnose COVID-19 patients, we provided support for a variety of diagnostic tests including PCR tests, emergency screening tests, and antigen-based tests.

○ We also prevented treatment gaps for non-COVID-19 patients by offering medical fees for contact-free treatment on a temporary basis, designating hospitals that ensure the separation of respiratory patients from non-respiratory patients and respiratory patient-exclusive clinics, and providing support for night-time nurses and additional healthcare workers.
□ Amid the provision of expanded support, NHI finances were stably managed within the pre-planned scope.

○ As of the end of 2020, the NHI reserve fund stood at approximately KRW 17.4 trillion, an increase of KRW 2.7 trillion from the KRW 14.7 trillion projected at the time of establishing the first Comprehensive Plan of National Health Insurance in 2019.

○ To ensure stable financial management, we increased efficiency in expenditure (reducing benefit payments by 1-3% each year) and expanded government grants for NHI (KRW 6.9 trillion in 2017 → KRW 9.5 trillion in 2021; an increase of 38.2% over four years).

- The NHI contribution rate was raised by 2.91% on average, which is lower than the average (3.2%) of the ten-year period (2007-2016) prior to the implementation of the Initiative, and thus is evaluated to have reduced the burden of insurance contributions as well as healthcare expenses for the public.

□ Minister Kwon Deok-chul said, “We will continue to reinforce NHI protection to reduce healthcare expenses and provide much-needed support for the insured in need.”

○ President Kim Yong-ik stated, “We will strive to complete the remaining tasks of the Initiative as scheduled until next year to build a country free from worries about healthcare expenses.”

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