A quick X-ray could cost you—or rather, your insurance company. The Ministry of Health and Welfare is addressing concerns that some social insurance institutions are denying coverage for X-rays performed in under 6 minutes and echocardiograms taking less than 30 minutes, sparking debate over fair reimbursement for essential diagnostic tests.
The Ministry of Health proposes guaranteeing the rights of patients covered by health insurance when assessing the cost of medical examinations and treatments.
Time Standards Under Scrutiny
The Ministry of Health and Welfare is seeking to clarify payment policies for diagnostic imaging, ensuring patients aren’t penalized for efficient medical care.
- The Ministry of Health and Welfare is addressing concerns about denied insurance claims for quick X-rays and echocardiograms.
- Current time standards for these procedures are intended as guidelines, not strict payment rules.
- The Ministry emphasizes that the entire process—not just equipment runtime—should be considered when determining reimbursement.
- Officials are urging cooperation between insurance institutions and medical facilities to investigate potential abuse of services.
According to the Ministry of Health and Welfare, the time standards outlined in the Professional Guide on Radiological Diagnostic Imaging Procedures are meant to serve as average reference points. These standards, developed based on common practices in healthcare facilities, aim to standardize technical procedures, prioritize patient safety, and maintain professional quality.
However, officials stress that these time-based standards are for professional guidance only. They are not intended to be rigid, legally binding rules used to solely calculate and reimburse health insurance costs. The time logged by equipment—radiation emission, scanning, or ultrasound duration—only reflects a portion of the overall procedure.
The complete process encompasses much more: identifying the patient, positioning, reviewing medical history, comparing results with previous scans, explaining findings, consulting with colleagues, interpreting the images, and transferring the results to the system. The actual time needed can vary significantly based on a patient’s condition, the complexity of the case, the qualifications of personnel, the available facilities, and the level of automation in the equipment.
Therefore, it’s inappropriate for social insurance institutions to deny coverage based solely on equipment-recorded time compared to the guidelines. A more holistic approach is needed.
Protecting Patient Rights
To ensure consistent implementation, legal compliance, and to safeguard the rights of both patients and medical institutions, the Ministry of Health proposes that health insurance reimbursements for radiography services should not be tied to the time standards in the Professional Technical Procedure Guidelines. Instead, the evaluation should be comprehensive.
The evaluation and payment process should consider the suitability of the procedure for the patient’s condition, adherence to established professional steps, the clinical significance of the results, and the resources available at the medical facility. Currently, settlements between social insurance institutions and medical facilities for certain technical services, such as plain X-rays, are being reviewed.
Ministry of Health officials also requested that social insurance institutions collaborate with medical facilities and local health agencies to investigate any unusually high growth rates or suspected abuse of technical services, following proper legal procedures.
