President Yoon Seok-yeol presides over the first state affairs inspection meeting held at the Blue House hotel in Seoul on the 15th. random news
“Some people go to the hospital thousands of times a year for medical shopping, and there are cases where they use an expensive MRI (Magnetic Resonance Imaging) without restriction.”
On the 15th, President Yoon Seok-yeol presided over a meeting to review state affairs and once again criticized ‘Moon Jae-in Care’ (policy to expand health insurance coverage) and mentioned this. This was only two days ago at the Cabinet meeting on the 13th. Moon Jae-in Care is a popular populist policy that wastes taxpayers’ money.‘, and it is in the same context as saying that it has damaged the foundation of the health insurance system.
This led to the reasoning that the Moon Jae-in administration expanded health insurance, causing a severe medical shopping situation, and because of this, health insurance funding declined. naturally It is also used as a basis for preventing the expansion of insurance, which has been consistently promoted regardless of progressive and conservative governments.do.
Coverage expansion and medical shopping are ‘two sides of the same coin’
As President Yoon mentioned, the case of visiting the hospital thousands of times a year is actually something that has been noted recently.
According to Health Insurance’s ‘Top 10 Outpatient Status in 2021’, last year a woman in her 40s visited a total of 24 medical institutions. Outpatient treatment 2050 timesI received Mr 26.9 million health insurance contribution earnedthis was spent
The other 8 patients also received outpatient treatment between 1207 and 2050 times a year, incurring significant costs.
A similar case was also revealed through the National Audit Data in 2020, but the year before B, a man in his 20s, visits the hospital 3062 times a yearhe did Gunbo paid 32.43 million won.
This period is the period when the coverage is extended with Moon Care. then Was there no medical shopping before?
Reporter Ryu Young-joo
Medical shopping has been discovered every year regardless of Moon Care in local governments across the country that engage in activities to prevent medical shopping by medical beneficiaries. Chungcheongnam-do In 2016, Mr C spent 46.5 million won in medical expenses when moving from one medical institution to another.while repeating admission to and discharge from a nursing hospital D, who had medical expenses of 25.8 million, won It also received the highest rating nationwide for its medical case management.
2012, 10 years ago The National Assembly’s Research Service journal (issues and issues) covered ‘medical shopping problems and countermeasures’, mentioning that the media was focusing on medical shopping at the time.
Issues and problems are “In fact, medical shopping is neither a thing of the past nor today.“he said”The number of outpatient visit days, the number of medical institutions visited, and the number of patients in the top 1% in the number of days administered continue to increase.he did,” he said.
older than this The situation was similar 20 years ago.. According to health insurance data, in 2001, 7 to 9 local hospitals were visited per day, or between 5 and 6 months. Patients who have had 5 to 8 operations such as anus, cataract, and cholelithiasiscause comes out. Even at this time, Gunbo”It has been analyzed that it is becoming a burden factor for health care funding.” he was worried.
President Yoon and the government are addressing health insurance financial spending for ultrasound and MRI, the coverage of which has been expanded with Moon Care.
This is because financial expenditure for cerebral and cerebrovascular MRI was 252.9 billion won last year, 23% more than the target (205.3 billion won), and expenditure for lower abdominal and urinary ultrasound was also increased by 37% from the target of 68.5 billion won.
Of course, here too, ‘medical shopping’ took place, where unnecessary examinations or repetitions were carried out. However, in light of past cases, when insurance expanded, ‘medical shopping’ also increased. This is because the number of diseases for which patient burden is reduced is increasing.
Chronic problems more serious than medical shopping
On the afternoon of the 15th, at Inwang Market in Seodaemun-gu, Seoul, merchants watch the live broadcast of the first state affairs inspection meeting presided over by President Yoon Seok-yeol. Reporter Hwang Jin-hwan
Yoon Kim, a professor of medical management at Seoul National University School of Medicine, asked back, “Medical shopping did not exist before Moon Care, and is it likely to disappear when the current government ends?” And they are focusing their efforts on attacking the last government.”
Although the government is preparing measures to reduce funding related to ultrasound and MRI, more serious chronic problems remain.
A typical example is the population Over-medication leading to an over-supply of bedsAll. As of 2020, Korea has 13.2 hospital beds per 1,000 population, three times the Organization for Economic Co-operation and Development (OECD) average of 4.4. Because hospitals have many beds, unnecessary hospitalizations are needed to make a profit, which depletes health care funding.
Professor Kim said, “Unnecessary hospitalizations will account for about a third of the total.”If the supply of beds is adjusted according to the Medical Act, about KRW 11 trillion of medical costs (health insurance contributions) can be reduced.” he estimated.
This amount is more than five times more than the 200 billion earned that the Audit and Inspection Board estimated was the amount of leaks due to Moon Care.
In addition, the current situation is where revenue increases only when the amount of treatment is increased fee-for-service, Excessive coverage of private medical indemnity insurance It is also identified as a problem.
together Appropriate management of patients with chronic diseases in primary medical institutionsThere are also comments that even if you do this, you can save trillions of money earned in health insurance funding.
Will medical shopping be the reason for the decline in insurance?
Former President Moon Jae-in. Provided by the Democratic Party
Concerns are being raised about signs of insurance retreat due to long-standing medical shopping problems. The constant work of promoting the strengthening of insurance under previous administrations was aimed at easing the public burden of medical costs and reducing medical vulnerabilities for the economically disadvantaged.
Thanks to Moon Care, 62.7% in 2017 health insurance rate(Ratio of health insurance burden to total medical costs) in 2020 65.3%get up to
but The original goal of 70% was not reached., It is far from the OECD average of 80%.
In this situation, the government has carried out a review of the current plan to further expand the scope. It has since become unclear the benefits of MRI for musculoskeletal disorders such as shoulders.
Leave a ‘Moon Care Flip’ Skepticism is not a paving stone with medical privatization in mindThere is also a look from The health insurance union issued a statement and said, “We emphasized financial stability and handed over public responsibility to the people. Even the governments of Lee Myung-bak and Park Geun-hye pay for MRI, ultrasound, and some serious diseasesHe said, “I can’t help but suspect that the decline in health insurance inevitably expands the private insurance market, such as indemnity insurance, and the privatization of medical care, which increases the profits of private hospitals, is the end point. ”
