[Issue] 2013, Issue 3 – In Focus, Social Affairs
Survey results of three uninsured medical fees

Nam Eun-kyung
Director, Social Policy Team

President Park pledged to expand coverage of the National Health Insurance (NHI) by covering three uninsured medical fees (selected treatment fees, higher rates of patient room fees, and nursing fees) of four serious illnesses (cancer, cerebrovascular and cardiovascular illnesses, and rare diseases). The government recently announced an insurance program to cover 100% of the expenses of the four serious illnesses. According to the program, two classifications will differentiate medical coverage, required medical care and selective medical care. The program will also differentiate private pay. However, the three uninsured items have been labeled as non-payable, and as such are not covered by the insurance. Collectively, they pose the biggest financial burden to patients. In response to this problem, the government has mentioned they are planning to improve coverage for these three uninsurable medical fees.

The program is filled with contents which do not reflect the demands of citizens for guaranteed health insurance. Among the four serious illnesses, the current program covers items that are not significant burdens to patients. On the other hand, items that are significant burdens to patients, such as the three uninsured medical fees, are not included in the program. Items that are financially ineffective are classified as ‘selective pay,’ and increase the burden on patients. 

There is also an issue with the decision making process of the program. The program was determined without the input of the National Health Insurance Policy Deliberation Committee, which has authority to review and make decisions/or provide recommendations, even with programs related to the standards and finance of medical care with health insurance. 

To implement President Park’s pledge, 100% coverage of four serious illnesses, it must be a priority to resolve the three uninsured medical fees because they are the biggest financial burden to patients. The Health Insurance Subscribers Forum, which includes CCEJ, conducted a survey to demonstrate what citizens demand out of government coverage for the four serious illnesses. From May 1 to 31, 2013, 1,032 people were surveyed across the nation, via internet and face-to-face interview. The credibility is 95%, and sampling error is ±3.1%

 Questions and Reponses

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* The selective medical service: A policy to select certain doctors for treatment purposes. There is an additional service fee for the selected doctors and the fee is charged to the patients without insurance subsidy. 

Only 33.3% responded they know the service well. Survey participants indicated that they had not been introduced to general doctors. 
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As far as the reason why respondents chose the selective medical service, the highest percent said they had accepted the service based on the recommendation of the hospital, rather than their own decision. Some respondents answered that they did not ask for the service, but they realized they been assigned the service when they paid their bill. Results also indicate that the service was chosen without sufficient notification or information. 

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 14.6% (108 responders) said they hired a caregiver for their care, or for a family members’ hospitalization. 20% said they had a family member take care of them while sick. 72.2% (562 respondents) said that the reason the family member took care of the patients was due to financial and physical burden on the care givers. 81.35% of the respondents who had previously been hospitalized said they had prior experience with a premium patient room. Among them, 72.1% (452 respondents) said they did not want a premium patient room but that there were no regular patient rooms available, or that they did not want to wait for a regular patient care room to become available before receiving care.

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Other than the three uninsured medical fee items, 68.5% (693 responders) said that image diagnosis should be covered as soon as possible. It follows that patients are experiencing financial hardship due to image diagnosis fees. 
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86.8% (874 respondents) said they expected that the three uninsured medical fees would be fully or partially included in the coverage, as state by President Park. 

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Regarding the improvement of the three uninsured medical fees system, 79% (796 respondents) said that the fees have to be included in the pledge implementation, or implemented by phases, depending on the financial situation. On the other hand, 18.8% (189 responders) said portions of the three fees have to included, and 2.2% (22 responders) said the pledge does not have to be fulfilled because it was only to win the election. 

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Lastly, regarding the question of the coverage rate, the actual rate is 63%, but respondents believed on average that it covered 53%. It shows that the respondents believe the health insurance covers fewer than it actually covers. It is understood that patients in large hospitals perceive themselves to have lower health insurance coverage because private insurance charges higher fees in order to include the three uninsured medical fees. 
The government is investing a few hundred million won each year to strengthen the coverage of the national health insurance, but the coverage rate is limited due to skyrocketing uninsured medical fees. Therefore, solutions to the uninsured medical fees are urgently needed. The Health Insurance Subscribers Forum, including CCEJ, is introducing suggestions based on these survey results. 

The selective medical service, as indicated by these survey results, is charged sometimes without the patients’ agreement or notification. The practice of forcing patients to choose the selective medical service without their full understanding and consent must be stopped. The service was intended to reduce the wage gap between public officers and doctors at the public hospital, but it deteriorated into a method for exacting higher medical fees at the pricier general hospitals. Therefore, the quality of medical service it provides and its cost must be reviewed.

The premium patient room has become an entry step for patients needing hospitalization rather than a desire of their own chosing. Therefore, it is necessary to clarify that the patients are not required to pay for unwanted premium patient care rooms, and for those that do choose premium patient care rooms, there needs to be detailed information regarding the payment subsidy for the premium room. The definition of a premium patient care room has to be a room for less than the standard number of patients at the national health insurance, and there must also be classification for premium rooms, in terms of the number of patients allowed per room and area per patient. 

Care giver fees are currently paid by the National Health Insurance to hospitals as compensation for offering all forms of treatment for patients at the hospital. But hospitals do not hire enough nurses or caregivers to provide care for the patients, and so the fact of nursing the patient becomes a burden to the family of the patient. It must be legislated that appropriate and sufficient nursing and care giving be provided to patients, and that the hospitals must hire enough nurses and caregivers to meet the needs of all patients in the hospital, so that the patient’s families are not left alone to provide adequate care for their loved ones. Moreover, nursing without legal license must be prohibited at the hospitals. 
President Park pledged to achieve 100% coverage of four serious illnesses. There are a few challenges but the coverage of four serious illnesses is key to resolving non-payment of the National Health Insurance. The government must place the priority on the three uninsured items, which are the main cause of medical related financial burdens, but it needs to be done while also considering the  other financial and related conditions. The government has promised that there is going to be an improved system for the three uninsured medical services. The citizens will remain watchful until the pledge is fulfilled.