□ The rapid drainage of the healthcare budget is attributed to the recent medical reform carried out to promote the separation of hospitals and pharmacies, rather than to internal factors, such as the increase in income levels, population aging, or wage expansion.
◦ This is inferred from the fact that the growth rate of imports has remained more or less unchanged from that of the previous year, whereas expenditure has grown to double that of last year, suggesting that the budget drainage is due to recent policy changes.
◦ The cost of maintaining and operating the medical insurance scheme represents only five percent of the total expenditure, and insurance revenue has reached the same level as that of last year. Therefore, the drainage cannot by fully explained by the integration of medical insurances.
◦ The costs associated with the payment of wages and other expenses explain this year’s surge in spending on medical insurance schemes. However, the costs of hospitalization and treatment increased by only nine percent following the hospital-pharmacy separation, whereas outpatient care costs reported a massive 72-percent hike, strongly hinting that the hospital-pharmacy separation is responsible for the drainage, as the separation mainly impacted the outpatient departments of hospitals.
□ Despite the initial expectations that it would be a cost-effective measure for preventing cases of pharmaceutical misuse and abuse, the separation drained the budget at a remarkable rate, due to problems with the plan’s initiation process.
◦ Total medical fees saw a cumulative increase of 49 percent, which opened the door for potential overtreatment in the form of prescription costs paid outside the hospital and compounding costs.
◦ Abandoning this reform of the reimbursement system, which could have proved greatly effective in offsetting the rise in treatment costs, is likely to cause another substantial jump in medical fees.
□ Financial stability in medical insurance schemes can only be achieved by correcting the errors made in the early stages of the hospital-pharmacy separation and alleviating the internal factors contributing to the deficit.
◦ Expanding government spending is necessary in the short term in order to ensure that the expenses are paid. However, this is only a temporary measure. More effort and a different approach are required to get to the fundamental root of the problem.
◦ Also, increasing insurance fees is unavoidable yet poses a significant challenge, as the public will not support the decision unless conscientious efforts are first made to readjust some of the unreasonable increases in hospital costs, ensure integrity in the validation of treatment costs, make electronic transactions mandatory, and devise realistic cost-reducing plans.
◦ The simplest approach to reducing expenditure is to gradually replace the current fee-for-service (FFS) payment model, where physicians are paid depending on the quantity of care, with a bundled payment system, where the type and severity of illnesses are taken into account when reimbursing physicians.
의료보험재정 위기(The fund crisis of the national medical insurance)
원인과 대책(Its causes and counter measures)
[서울] : 한국개발연구원
|Series Title; No||정책포럼|
|Subject Country||South Korea(Asia and Pacific)|
|Subject||Social Development < Health|
|Holding||KDI; KDI School|