[Reporter’s view] Expanded catastrophic medical expenses

Heading towards single-payer healthcare

Among foreigners, the saying, "If you are ill, you should go to Korea," had once become a trend.

 

Foreigners that stay in the country for over 6 months are eligible for the National Health Insurance subscription as a local subscriber, allowing them to receive reimbursement benefits.

 

This issue has been a topic of heated debate during the annual National Assembly audit.

 

As a result, the National Health Insurance Service (NHIS) has been implementing safety measures every year to prevent foreigners from freeloading on Korea's National Health Insurance.

 

For foreigners, the National Health Insurance is a cost-effective benefit, but there are Korean citizens who cannot afford medical bills even with the National Health Insurance coverage.

 

In the past, when the cost coverage was not high enough, medical bills used to be one of the top three causes of household bankruptcy.

 

In Korea, many citizens still subscribe to private health insurance.

 

Starting in the early 2000s, there was a movement with the initiative "Single-payer healthcare: all medical fees to be covered by National Health Insurance," but it was often seen as an empty slogan.

 

In response, the government introduced measures to alleviate the financial burden on the people.

 

These measures included the introduction of the copayment maximum in 2004, the special assessment for cancer, cerebrovascular disease, and heart disease in 2005, and the implementation of the Catastrophic Medical Expenses Support Program in 2013.

 

The Catastrophic Medical Expenses Support Program is designed to alleviate the burden of medical fees on households facing excessive expenses, and its insurance coverage is expanding.

 

At a recent cabinet meeting, the partial amendment to the "Enforcement Decree for the Catastrophic Medical Expenses Support Program," was approved.

 

Starting on January 1st, 2024, the Catastrophic Medical Expenses Support Program will be expanded to include all medical conditions that occurred within one year prior to the final inpatient or outpatient treatment.

 

Prior to the revision, the previous system combined all medical expenses for inpatient care, but for outpatient care, it only considered expenses for the same disease, and application was restricted to the six major severe diseases.

 

Even if the total medical expenses for the entire year reached the standard for the Catastrophic Medical Expenses Support Program, there were situations where support could not be provided because the standard was not met for the same diseases alone.

 

Starting next year, with the expansion that includes all diseases, reimbursement for catastrophic medical expenses can be claimed if the total medical expenses for all conditions exceed 4.1 million won.

 

Previously, a four-person household earning 100% of the median income could only apply for support if medical expenses for the same condition exceeded 5.9 million won.

 

However, lowering the standard means that more people will be able to benefit from catastrophic medical expense support.

 

The Catastrophic Medical Expenses Support Program is designed to prevent households from facing financial disaster due to medical expenses.

 

Questions have arisen regarding the implementation of reimbursement for all types of diseases, including non-reimbursement and total copay, selective reimbursement, implants for those aged 65 and older, double and triple room hospitalization fees, Chuna manual therapy, and senior dentures, based on income levels.

 

The National Health Insurance system was established to enhance the quality of national healthcare and improve social security.

 

To ensure that people do not have to worry about medical expenses, catastrophic medical expenses coverage should be expanded to include all diseases could serve as a significant step toward the establishment of a single-payer healthcare system.