□ The Ministry of Health and Welfare (Minister Kyu-Hong Cho) and the Health Insurance Review and Assessment Service (President Seon-Min Kim, hereinafter ‘HIRA’) published the 2022 uninsured medical expenses by medical institution on the website of the Review and Assessment Service (www.hira.or.kr) ) and the ‘Healthy e-eum’ mobile app.
□ Disclosure of excluded medical expenses It is implemented according to target.
* Treatment materials (138), MRI (74), ultrasound examination fee (73), vaccination (63), functional test fee (46), treatment and surgery fee (38), dental treatment and surgery fee (20), dental prosthesis fee (14) ), prosthesis (12), test fee (31), others (69)
Results of investigation into excluded medical expenses
□ As a result of examining the average price per non-wage item, 75.6% of the total price was increased and 22.9% decreased.
○ However, based on the inflation rate of 5.0% in November 2022 (compared to the same month of the previous year), the rate of increase above 5.0% among all items was 14.9%.
□ Rates of increase in the price of major non-payroll items, which have been increasing recently following loss insurance, and the differences between organizations are as follows.
◇ Causes of deviation among large non-payroll organizations
① (Cataract) Clinic A in Busan receives KRW 330,000 (minimum) and Clinic B in Incheon receives KRW 9 million (maximum) for the same multifocal lens for cataract surgery (EYHANCE IOL TECHNIS).
② (Manual therapy) Clinic C in Seoul receives KRW 100,000 (median amount) and Clinic D in Gyeonggi receives KRW 500,000 (maximum) for manual therapy.
③ (HIFU procedure) For ultrasound-guided HIFU procedure, hospital E in Gyeonggi Province receives 2 million won (minimum) and clinic F in Gyeongnam receives 25 million won (maximum).
※ This content is analyzed for ‘medical cost’ only among the data submitted by medical institutions, and the difference in price between medical institutions depends on various factors such as the standard of treatment, difficulty level, manpower and equipment, and etc.
① Multifocal lens for cataract surgery (accommodating intraocular lens): the average price increased by 4.1%, the highest price (9 million won) 5 times higher than the median price (1.8 million won)
② Manual treatment: 4.9% increase in the average amount, 5 times the maximum (500,000 won) compared to the median amount (100,000 won)
③ HIFU (high intensity focused ultrasound) procedure[자궁근종])*: The average price of ultrasound 34.8% ~ 57.3% MRI of increase, the highest price (MRI 9.8 million ~ 25 million won ultrasound) 1.54 ~ 2.94 times the median price (MRI ~ 8.5 million won)
* Ultrasound treatment for removal of uterine fibroids, etc., is divided into MRI-guided method and ultrasound-guided method.
④ Nasal valve reconstruction *: Average price increased by 0.9%, highest price (20 million won) 12.5 times the median price (1.6 million won)
* Surgery to maintain or expand the ‘nasal valve’ inside the nose for the treatment of rhinitis, etc. There are cases where medical treatment insurance and loss insurance are claimed along with rhinoplasty surgery.
⑤ Varicose vein surgery*: Average amount 11.2% Inha Ultrasound-guided Sclerotherapy ~ 6.7% Highest amount compared to the median amount (710,000 optical vein ablation ~ 300,000 Ultrasound-guided sclerotherapy won) (1.4 million optical venous sclerotherapy won 1.4 million ~ 1.4 million optical venous sclerotherapy (ultrasonography-guided sclerotherapy) 1.97 optical venous suction ablation ~ 33x ultrasound-guided sclerotherapy
* High frequency endarterial occlusion, optical vein suction ablation, saphenous vein occlusion using cyanoacrylate, laser vein occlusion, ultrasound guided sclerotherapy (all treatment materials are separate)
Improving information retrieval methods
□ This year’s disclosure provided enough information to enable reasoned judgment when choosing uninsured treatment, and the content of the information was also improved in an easy-to-understand manner. The specific details are as follows.
① The disclosure method has been improved so that detailed information related to treatment (manpower, facilities, equipment, etc.) * can be checked at the same time as price information.
* (Current) Only price information is presented, detailed information can be checked by clicking ‘View Details’ → (Improved) Shows price and detailed information at the same time
② Added easy * keyword search function to find complex non-salary names easily.
* (Example) Keywords such as ‘gastroscopy’, ‘sleeping’, and ‘endoscopy’ are entered to search for sedation endoscopy patient management fee Ⅱ
③ In order to protect users from low-cost marketing and inappropriate commercial use of data, it is mandatory to check ‘Notes on Public Data Use’.
* ① Even for the same items, there may be differences in the amount between medical institutions depending on manpower, facilities, equipment, difficulty, etc. ② The total cost of treatment may be different depending on the act of treatment with each other and treatment materials can be punished if
Measures to improve non-pay disclosure system
□ (Selection of non-salary benefits for priority management) The Ministry of Health and Welfare is reviewing ways to select non-salary items that require intensive management and improve the quality of information provided so that the system can unpaid disclosure achieves the goal of improving consumers’ right to know.
○ Intended to support rational use of medical services by selecting uninsured items of high social interest* or high medical importance and providing detailed information such as safety and efficacy.
* (Example) Items with large or rapid increase in non-attention: ① Cataract multifocal lens, ② Manual treatment, ③ HIFU procedure, ④ Nasal valve reconstruction, ⑤ Thyroid radiofrequency ablation, ⑥ Varicose vein surgery
□ (Diversify disclosure methods) Considering the various characteristics of non-benefit benefits, consider diversifying disclosure methods according to the nature of each item.
○ In cases where the difference in services between medical institutions is not great, such as vaccination, the current method of price-based disclosure is retained,
○ In cases where there is a clear difference in service between medical institutions, such as various surgeries and procedures, various indicators, including the infrastructure of medical institutions such as workforce and equipment, will be developed and disclosed together.
○ In particular, for items with major concerns about side effects*, such as low price incentives, low quality treatment, and tying of other treatments, we intend to seek a reasonable disclosure method through discussions with the Advisory Non-Beneficial Management Policy Body**.
* Example: A case of very low price marketing of implants in so called ‘dump dentistry’ (dentistry which provides low quality medical treatment after attracting patients with low priced products or provides medical treatment at a price high)
** Participate in the Ministry of Health and Welfare, the medical community, user groups, experts, and related organizations
□ Kang Joon, head of the Medical Safety Management Division at the Ministry of Health and Welfare, said, “It has been two years since the disclosure of uninsured medical costs for all medical institutions, including those at the clinic level.”
○ “We have been focusing on the quantitative expansion of the disclosure system until now, but we will strive to develop it into a system that provides practical support in terms of user choice through qualitative development in the future,” he said.
1. Key analysis results
2. Main details of the improvement in the method of disclosure of medical costs not included
3. Disclosure of excluded medical expenses
