Last year, the deficit of comprehensive health insurance reached 1.62 trillion won, a decrease of about 350 billion won compared to the previous year (1.97 trillion won). However, the phenomenon of concentration is deepening, with payments for specific non-covered treatments such as non-covered injections and physical therapy accounting for 35% of the total.
According to the Financial Supervisory Service on the 12th, last year, the deficit of comprehensive health insurance for property and casualty insurers amounted to 1.5788 trillion won, while life insurance companies recorded a deficit of 437 billion won. The property and casualty insurers' deficit decreased by 405 billion won compared to the previous year (1.9838 trillion won). The life insurance sector reported a profit of 9.1 billion won in 2023 but had turned to a loss last year.
The loss ratio, calculated by dividing the loss amount by premium income, was 99.3% last year, a decrease of 4.1 percentage points compared to the previous year (103.4%). This is due to the decline in the loss ratio of the first and second generation, which had consistently raised premiums, as well as a slight decrease in the loss ratio of the third and fourth generations.
Last year, the loss ratio by product was 97.7% for the first generation, 92.5% for the second generation, 128.5% for the third generation, and 111.9% for the fourth generation. The first generation saw a decrease of 12.8 percentage points from the previous year. The second generation decreased by 0.2 percentage points, the third by 8.7 percentage points, and the fourth by 1.9 percentage points.
Last year, payments from comprehensive health insurance amounted to 15.2 trillion won, an increase of 8.1% compared to the previous year (14.0813 trillion won). Of this, payments for covered treatments increased by 7.7% to 6.3 trillion won, while payments for non-covered treatments grew by 8.4% to 8.9 trillion won.
In particular, the payments for non-covered injections such as nutritional supplements totaled 2.8 trillion won, and for musculoskeletal disorders like physical therapy, they reached 2.6 trillion won. This accounted for 35.8% of the total insurance payments, significantly exceeding the payments for cancer treatment (1.6 trillion won).
Payments related to non-covered insurance for new medical technologies such as knee stem cell injections and prostate ligation are also on the rise. Annual payments for knee stem cell injections jumped from 14.7 billion won in 2022 to 64.5 billion won last year, and prostate ligation increased from 26.2 billion won to 43.8 billion won during the same period.
The share of payments from clinics was the highest at 32.2%. Hospitals accounted for 23.3%, general hospitals for 17.3%, and tertiary hospitals for 14%. Notably, non-covered treatments accounted for 66.1%, with clinics at 37.5% and hospitals at 28.6%.
Payments from oriental medicine hospitals amounted to 593.9 billion won, a 16.1% increase from the previous year, while payments from Korean medicine clinics rose by 28.6% to 151.1 billion won, influenced by the expansion of the coverage for traditional herbal medicine last April.
The amount of non-covered insurance payments per comprehensive health insurance case was the highest for the first generation at 400,000 won, nearly three times that of the first generation (136,000 won). The second generation received 254,000 won, and the third generation 182,000 won. Financial authorities interpret this as a result of continuous institutional improvements, including raising the cost-sharing rate for non-covered treatments, which has reduced unnecessary excess non-covered treatments.
The FSS noted, "While the performance and loss ratio of comprehensive health insurance have improved, this is mainly due to premium increases rather than measures to prevent payout leaks," and pointed out that there is a deepening concentration of insurance payments for specific non-covered items such as injections and physical therapy, particularly in clinics and hospitals, indicating a need for improvement.