In order to resolve the imbalance in the compensation system for medical procedures, the government is raising the fees for approximately 1,000 serious surgeries that have been undercompensated. In addition, it plans to limit concurrent treatment with reimbursement for non-covered items that are excessively performed beyond medical necessity.
At a briefing on the status of medical reform at 11:00 AM on the 13th, Jeong Gyeong-sil, head of the Medical Reform Promotion Team, said, “Because it is difficult to adjust all the fees at once, we are reviewing a plan to select and increase the fees for about 1,000 severe surgeries with low compensation levels that are mainly performed at general hospitals and general hospitals.”
Our country’s fee system is based on the ‘fee-for-service system’, in which a unit price is set and paid for each individual act.
The fee schedule is set for approximately 9,800 acts, divided into six types: basic treatment such as hospitalization and examination, surgery, treatment, specimen, imaging, and function. However, the compensation level is low for basic treatment, surgery, and treatment, while the compensation level for specimen, imaging, and function types is generally high.
Director Jeong said, “We have established a ‘Medical Cost Analysis Committee’ within the Health Insurance Policy Deliberation Committee, and the committee will establish a foundation for more scientific analysis of the costs that form the basis of medical fees.” He added, “We expect that by reviewing the validity of basic data such as time, risk, and labor costs and the appropriateness of medical fees, the fee adjustment system will become more scientific and transparent.”
He continued, “In the case of fields such as surgery and treatment, compensation is currently being provided at a level significantly lower than the cost, so we plan to implement pincet compensation to first strengthen compensation in the fields of surgery and treatment,” and explained, “We are preparing to first implement a first-stage increase within the year or by January of next year at the latest.”
The government announced that it would strengthen public policy fees in six areas that require concentrated investment: critical and difficult essential treatment, emergency care, nights and holidays, children and childbirth, and vulnerable areas.
We will also improve the value-based payment system. To this end, we will establish a uniform surcharge system for each type of medical institution. Currently, a 15% surcharge is added to the fee for all general hospitals, but we plan to change this to a structure where more compensation is given for severe cases and less compensation is given for mild cases.
We are currently reviewing ways to improve the non-covered treatment disclosure system to go beyond the level of disclosing unit prices for each item and disclose total treatment costs, safety and efficacy evaluation results, and alternative covered treatments, so that patients and consumers can rationally choose non-covered treatment.
Director Jeong said, “Even in the so-called discussion, there was an opinion that detailed information such as the non-covered rate by medical institution should be disclosed, and medical institutions with a high proportion of non-covered treatments should be publicly announced so that medical consumers can reasonably choose institutions that implement non-covered treatments appropriately.” He also said, “We plan to limit concurrent treatment with covered treatments for non-covered treatments that clearly have concerns about over-reliance, such as manual therapy, cataract surgery with non-covered lenses, and nasal valve reconstruction surgery (to treat nasal congestion).”
He continued, “As a result of the monitoring of the non-covered treatment status, it was suggested that a management system utilizing the current selective payment system should be established so that non-covered treatment with a high risk of overpayment can be continuously managed through setting standard prices, analyzing treatment data, re-evaluation, etc.”
Director Jeong said, “There were also opinions that the statutory out-of-pocket coverage of health insurance should be optimized in order to minimize some of the negative impacts of actual loss insurance on the medical delivery system and medical utilization,” and explained, “We are preparing measures to improve the overall system, such as rationalizing the scope of actual loss insurance coverage, improving the management and contract structure of actual loss insurance products, and establishing a cooperative system with health authorities.”
Regarding the request by the Emergency Response Committee of the Seoul National University College of Medicine and Seoul National University Hospital Faculty Council to broadcast live or disclose the medical reform discussions as transcripts, Director Jeong responded, “If the special committee is disclosed, there is a concern that (the committee members’) statements may be restricted, and there is a possibility that it may be misunderstood that unreviewed matters have been decided on as policy.” He added, “Once the special committee’s activities are concluded, we will be able to fully disclose them through meeting minutes, white papers, etc.”
Director Jeong said, “In order for medical reform to be successful, there needs to be a change in the way the public uses medical services to which they have been accustomed,” and “I ask that those with relatively mild symptoms yield up the emergency rooms of general hospitals to seriously ill and emergency patients.”
Towards the medical professionals, Director Jeong said, “As experts in the medical field, I ask that you fully present your opinions and ideas through the Medical Reform Special Committee and expert committee windows.” He also emphasized, “The 14th is the day when the Medical Personnel Expert Committee will hold an open policy debate, and the more people participate in the deliberations in the public forum, the more socially acceptable medical reform plans will be produced.”
Reporter Kim Jeong-hyeon Photo News 1
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2024-08-14 02:50:50