NHI coverage rate 64.5% in 2021...Fell 0.8% YOY

Total coverage rate fell due to reduced coverage rate in clinic-level institutions

The National Health Insurance Service announced that Korea’s health insurance coverage rate in 2021 had fallen slightly from the previous year to 64.5%.

 

On the 10th, the NHIS announced so through the ‘NHI Patient Medical Expense Survey 2021’ report on the 10th In 2021, the NHI coverage rate decreased by 0.8%p YoY to record 64.5%, and the non-reimbursement burden rate increased by 0.4%p YoY to record 15.6%.

 

The NHI coverage rate is calculated by dividing the insurer’s reimbursement expenses by the sum of the insurer’s reimbursement expenses, legal copayment amount, and non-reimbursed medical expenses.

 

The total coverage rate in medical institutions has decreased due to decreased coverage rates in clinics despite the increased coverage in general or higher-level hospitals.

 

The expanded scope of reimbursement for ultrasounds [chest (amended in April 2021), heart (Sep 2021)] and the reduced use of advanced hospital wards (single-bed ward) led to a 0.5%p increase in the coverage rate in general or higher-level hospitals to 69.1%.

 

The coverage rate in clinic-level institutions fell 4.1%p due to the increase in the proportion of non-reimbursed medical services (+4.8%p) such as manual therapy (rehabilitation and physical therapy expense), and multifocal intraocular lenses for cataract surgery (treatment material).

 

However, the coverage rate for severe and high-cost medical treatments has increased continuously.

 

The coverage rate for the 4 major diseases was 84.0%(+0.1%p), and the coverage rate of the Top 30 severe and high-cost diseases (leukemia, pancreatic cancer, lymphoma, etc.) was 82.6% (+0.5%p), and Top 50 diseases (Top 30+dementia, pulmonary tuberculosis, etc.) was 80.3% (+0.2%p).

 

The coverage rate of those that belong to the age group - ‘5 years or younger (71.0%),’ and ’65 years or older (70.3%)’ - was higher than other age groups.

 

However, in the case of those in the ’65 years or older' group, their coverage rate in tertiary hospitals, general hospitals, and hospitals has increased, but their coverage rate in clinic-level institutions has fallen by 0.9%p from the previous year due to their increased use of manual therapy and multifocal intraocular lenses for cataract surgery, etc.

 

By income level, the NHI coverage rate (including the effect of the copayment ceiling system) of those in the lower-income bracket was higher than that of those in the higher-income quintile group (as classified by quintile of health insurance premiums), and the effect of the copayment ceiling system was found to be greater in the lower-income quintile group.