Reasons for Proposal
Medical costs in Korea are showing a noticeable upward trend compared to that of other OECD countries due to the rapid increase in medical costs for non-payment items not subject to health insurance. Such rapid increase in medical costs for non-payment items is the main reason why health insurance coverage is at standstill despite past governments’ efforts to strengthen health insurance coverage, so the burden of medical costs on the public is increasing.
Indemnity medical insurance is an insurance product that compensates for medical costs actually paid for by the subscriber at a medical institution including medical costs for non-payment items not covered by health insurance, etc. And, currently it has more than thirty million accumulated subscribers. Since the number of subscribers to indemnity medical insurance has risen by a wide margin in recent years, the rapid increase in its rate of loss due to ‘medical shopping,’ etc., and increase in insurance fees to make up for such losses have become social problems. Despite the fact that effective management of medical costs for the public requires an intimate coordination scheme between national health insurance and indemnity medical insurance, there are currently no legal or systematic devices for such a scheme.
Therefore, this proposal aims to enact an Act which enables health insurance and indemnity medical insurance to be managed in aggregate to strengthen health insurance coverage, ensure its sustainability, and promote the effective management of medical costs for the public by having indemnity medical insurance properly perform its function as a supplement to national health insurance.
Details
A. The purpose of this Act is to lessen the burden of medical costs for the public and to contribute to the public’s medical security and enhanced health by providing measures for national health insurance and indemnity medical insurance to be managed in aggregate (Article 1).
B. A Public-Private Medical Insurance Deliberation Committee shall be established under the Prime Minister to deliberate on matters related to changes in the public-private medical insurance system to lessen medical costs for the public, fact-finding investigations, utilization of relevant materials, etc. (Article 5).
C. The Minister of Health and Welfare and the Chair of the Financial Services Commission shall jointly conduct a regular fact-finding investigation at least once every year regarding public-private medical insurance and major issues related to medical costs for the public (Article 6).
D. The Public-Private Medical Insurance Deliberation Committee may submit its opinion regarding public-private medical insurance coverage range to the Minister of Health and Welfare and the Chair of the Financial Services Commission in cases where it is deemed necessary for the management of medical costs for the public (Article 7).
E. The Public-Private Medical Insurance Deliberation Committee shall submit its opinions to relevant administrative agencies, etc., to ensure that matters deliberated upon at the Committee shall be reflected in public-private medical insurance policies (Article 8).
F. The Minister of Health and Welfare and the Financial Services Commission shall enable the Prime Minister to utilize material submitted for fact-finding investigations in determining medical care benefit subjects, analyzing status of non-payment item costs, amending standardized terms and conditions and calculating the net premium rate of indemnity medical insurance, coordination of indemnity medical insurance disputes, etc. (Article 10).
G. The Minister of Health and Welfare shall take necessary measures to ensure that documents required for a patient to claim indemnity medical insurance payment in a health care institution shall be provided in electronic format (Article 11).
