Medical bills not covered by insurance account for 10 percent of healthcare expenses paid to public hospitals, a report shows.
The finding was part of the report titled “”A study to work out the management plan of effective medical cost operation,” commissioned on the Korean Academy of Medical Sciences (KAMS)대한의학회 by Health Insurance Review & Assessment Service (HIRA)건강보험심사평가원.
As the result of healthcare costs at 41 public medical institutions in December 2015, the uncovered medical expenses spent by outpatients amounted to 1.85 billion won ($1.63 million), or 9.63 percent of their total전체 medical costs. The average medical cost paid by outpatients was 45.3 million won.
The uninsured drug costs spent by outpatients reached 258 million won or 6.82 percent of the total, and that of uncovered treatment materials stood at 62.9 million won or 20.03 percent.
The gynecology department showed the highest share of uncovered bills with 30.9percent, followed by the neurosurgery department with 27.7 percent, and surgery department with 18.8 percent.
By medical treatment, the uncovered rate was high in ultrasonic waves. MRI, and conscious sedation endoscope while vaccines, nutritional supplements, and contrast in drugs showed higher rates among drugs.
Hospitalized patients spent 1.7 billion won, or 8.77 percent of total medical costs, as uncovered expenses, 149 million won (3.5 percent) for uncovered drug costs and 384 million won (19.51 percent) for uninsured treatment materials.
To solve the problem of uncovered costs, the report pointed out, the need to determine the public financing portion in healthcare costs and expand insurance benefits by starting to reduce disaster-related medical expenses.
Concerning the new Diagnosis Related Group (DRG) proposed as the alternative to solve medical expenses for uninsured drugs, the report said it couldn't be the alternative because of its unstable classification system and the lack of equity with private medical institutions.
“Because the patient classification system used in the DRG is based on medical costs, not original costs, if medical costs are allocated with the initial DRG, people request health insurance with the allocated costs next year,” the report said. “Accordingly, it is impossible to get treatment variables necessary for DRG improvement.”
“Because there aren’t standards for investment costs related to hospital structures, if medical costs per DRG are fixed, hospitals that make much investment experience the shortage of insurance coverage while those who make less investment tend to get more coverage,” it said.
DRG or new DGR will be able to play their roles only after people understand original costs, assign diagnosis names based on the coding guideline, and make use of it to develop the classification system, it added.