33M vs 40K: Loss Insurance Distorts Medical Market
Debate Focuses on Insurance Coverage for Conventional Korean medicine
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SEOUL,South Korea (May 1,2025) – A recent forum at the National Assembly addressed the contentious issue of including non-covered traditional Korean medicine treatments in loss-less medical insurance plans.Advocates argue that excluding these treatments limits patient choice and access to care, especially as South Korea’s population ages.
Arguments for Coverage
Lee Eun-yong,a professor of oriental medicine at Semyung University,presented a case for insurance coverage during the April 30 debate in Seoul. the discussion, co-sponsored by lawmakers Min Byung-deok, Lee Soo-jin, Lee Kang-il, and Jang Jong-tae, along with the Consumer sovereign Citizens’ Council and the Korean Medical Association, centered on the necessity of including traditional treatments in insurance plans.
Loss-less medical insurance, often described as a “second national health insurance” covering gaps in the primary system, currently insures over 40 million people. However, critics contend that standardized terms and conditions, along with successive policy revisions, have reduced coverage and increased financial burdens on patients. Notably, coverage for traditional Korean medicine was largely eliminated following the introduction of standard terms in October 2009. A 2014 recommendation by the National Rights Commission of Korea to rectify this has remained unaddressed by the Ministry of Health and Welfare and the Financial Services commission for over a decade.
Lee argued that the exclusion of treatments rooted in medical evidence and public demand from loss insurance distorts the medical market. She also suggested a correlation between the establishment of loss insurance terms in 2009 and a decline in real-world insurance subscriptions, from 13.18 million in 2014 to 11.13 million in 2023.
Lee illustrated the disparity with an example: a second-generation loss insurance subscriber might receive 290,000 won reimbursement for 330,000 won in expenses for water therapy or shock wave therapy. Conversely, treatments like herbal medicine, physical therapy, or medicinal acupuncture receive no coverage, even with insurance. “Loss insurance reduces the relative price of medical services, relieving patients’ economic constraints,” Lee stated.
Industry Concerns
The insurance industry, however, expresses reservations about the reliability of clinical guidelines and potential moral hazards. Lee Hyung-gae, a long-term insurance manager, noted the significant rise in auto insurance costs over the past decade, voicing concern about including non-covered traditional medicine.Kim Hee-kyung, head of the Insurance Association, echoed these concerns, citing a lack of clarity regarding the scope of treatment and procedures, leading to potential abuse and unclear medical expenses.
Financial authorities are reportedly considering the perspectives of both the traditional medicine and insurance sectors as they consider reforms for the fifth generation of loss insurance.
Korean Medical Association’s Stance
Yoon Sung-chan, chairman of the Korean Medical Association, emphasized the need to address existing problems and prioritize public welfare in any decision regarding the inclusion of traditional medicine in insurance coverage.
Korean Medicine insurance Coverage: Your Questions Answered
This article addresses the ongoing debate in South Korea regarding insurance coverage for traditional Korean medicine treatments. We’ll break down the arguments, the concerns, and the current state of affairs, providing clear answers to common questions.
Q: What is the core issue being debated regarding Korean medicine insurance?
The central issue revolves around whether or not to include non-covered traditional Korean medicine treatments in loss-less medical insurance plans. Advocates for inclusion argue that this exclusion limits patient choice and access to care.
Q: What are the main arguments in favor of covering traditional Korean medicine?
Patient Choice and Access: Excluding traditional treatments, especially as the South Korean population ages, restricts patients’ options for care.
Distortion of the Medical Market: The exclusion of treatments supported by medical evidence and public demand distorts the medical market.
Potential Impact on Insurance Subscriptions: Some, like Professor Lee Eun-yong, suggest a correlation between the 2009 introduction of loss insurance terms and a subsequent decline in insurance subscriptions.
Q: What is “loss-less” medical insurance?
“loss-less” medical insurance, sometimes referred to as a “second national health insurance,” is designed to cover gaps in the primary health insurance system. It currently covers over 40 million people in South Korea.
Q: What treatments are currently not covered under loss-less insurance?
Treatments like herbal medicine, physical therapy, and medicinal acupuncture frequently enough receive no coverage, even with insurance.
Q: Hasn’t this issue been addressed before?
yes. A 2014 recommendation by the National rights Commission of Korea to rectify the exclusion of traditional Korean medicine has remained unaddressed by the Ministry of Health and Welfare and the financial Services Commission for over a decade.
Q: What concerns does the insurance industry have about including traditional Korean medicine?
The insurance industry cites several concerns:
reliability of Clinical Guidelines: Concerns exist regarding the reliability of clinical guidelines for traditional treatments.
Potential Moral Hazards: The industry worries about potential abuse and unclear medical expenses due to the lack of clarity regarding the scope of treatments and procedures.
Cost Concerns: There are worries about escalating costs, referencing the importent rise in auto insurance expenses over the past decade.
Q: What is the Korean Medical AssociationS stance on this issue?
The Korean Medical Association,represented by Chairman Yoon Sung-chan,emphasizes the need to address existing problems and prioritize public welfare in any decision regarding the inclusion of traditional medicine in insurance coverage.
Q: What is an example of the financial disparity created by the current coverage?
A second-generation loss insurance subscriber might receive reimbursement for water therapy or shockwave therapy. However,treatments like herbal medicine receive no coverage,even with insurance.
Q: What key figures are involved in this debate?
Here’s a summary of key figures and their roles:
| Figure | Role | Stance/Concern |
| ——————– | ——————————————————————– | ——————————————————————————————————————————————————— |
| Lee Eun-yong | professor of Oriental Medicine at Semyung University | Advocate for coverage, highlighting limitations on patient choice and potential decline in insurance subscriptions. |
| Lee Hyung-gae | Long-term Insurance manager | Raises concern about the rise in insurance costs, voicing reservations, especially in the context of including less-regulated treatments. |
| Kim Hee-kyung | Head of the Insurance Association | Echoes concerns about a lack of clarity regarding the scope of treatment, leading to potential abuse and unclear medical expenses. |
| Yoon Sung-chan | Chairman of the Korean Medical Association | Emphasizes the need to address existing problems and prioritize public welfare regarding insurance coverage for Traditional Korean Medicine. |