[Editorial] Health insurance problem

South Korea boasts of a solid and affordable public health insurance system compared to other countries. Unlike the United States, for instance, it is rare to catch hospitals issuing Korean patients with surprise medical bills for relatively simple treatments at hospitals.

Although the national health system is far from perfect, it has been dependable for decades, due largely to the government’s systematic and detailed control over the items eligible for public insurance coverage and prices for treatments, medicine and related medical services.

But the very foundation of the much-touted system is now facing a serious turning point sparked by some flawed medical policies and bloated coverage plans. If the sickening system remains untreated, a big deficit will hit the National Health Insurance Service and threaten the country’s health insurance system, experts warned.

Against this backdrop, the Ministry of Health and Welfare presented a reform plan to President Yoon Suk-yeol in a briefing Friday. The ministry said it would focus on investing in “essential” medical fields and restructuring health insurance expenditure.

The need to beef up vital medical services such as surgery gained attention in the media after a nursing staff member at Asan Medical Center in Seoul, one of the country’s biggest general hospitals, collapsed on duty and died from a cerebral hemorrhage last month. The tragic incident sparked heated debates about the lack of intensive care unit beds and specialist surgeons at local hospitals, including top-tier university medical centers.

The Health Ministry said that it would draw up measures by the end of September to invest more in vital medical services that can save people in critical conditions to prevent tragic cases such as that of Asan Medical Center, and steer more support and resources to fields saddled with widening deficits and a chronic shortage of specialist surgeons.

The imbalance of medical services and specialist personnel has long been pointed out as a serious issue. A growing number of medical students prefer to specialize in popular and lucrative fields such as plastic surgery and dermatology, while avoiding high-risk yet less financially rewarding fields such as surgery, pediatrics and gynecology.

Experts blame the lopsided trend on the distorted medical fees set by the current health insurance system. If the pool of surgeons continues to shrink, it is forecast that Korean patients would struggle to find a doctor for an emergency appendectomy in about 10 years.

Equally serious are the distorted priorities of health insurance coverage. This is said to have been worsened by “Moon Care,” the expansion of health insurance coverage under former President Moon Jae-in.

The Moon administration sought to expand public health coverage for a wider range of medical treatments, including costly ultrasound and magnetic resonance imaging checkups as well as the use of emergency rooms. According to the Board of Audit and Inspection, the number of MRI checkups doubled after “Moon Care” was introduced, and such new checkups are estimated to cost more than 160 billion won ($119 million) to the health insurance budget over a three-year period during the Moon administration.

As a result, the country’s health insurance balance swung to a deficit in 2018 after running a surplus for seven straight years, and continued to be in the red in 2019. The Korea Medical Association claimed that once the COVID-19 effect is gone, the accumulated cash reserve for the national health insurance, currently at 20 trillion won, could quickly dry up in a few years if the nation fails to fix its problem-laden insurance rates.

The Health Ministry’s reform plan for the national health system is also expected to include a new policy that would affect foreign residents living in Korea. During his presidential campaign, President Yoon pledged to apply more stringent standards to reduce foreigners’ dependents’ access to the NHIS coverage, which was then a hot-button issue due to claims they were free-riding on the national health insurance system

Overhauling the country’s health insurance system with a single policy initiative, however, is easier said than done. The Yoon administration should pay particular attention to identify critical illnesses plaguing the broader system and try to prescribe necessary measures in the long run, however bitter they may be.

By Korea Herald (khnews@heraldcorp.com)