A, 40, who visited an obstetrics and gynecology clinic in southern Seoul's Gangnam district for itching around the vulva (the external female genitalia) and anus, went through something unexpected. After receiving injection treatment under propofol sedation, the doctor massaged A's vulva while A was asleep. A learned of this because a 100,000 won charge for manual therapy (a non-surgical method that uses the hands to treat muscles, joints and nerves) appeared on the bill. The hospital said it was necessary to ease muscle stiffness caused by the injection treatment and added it would prepare documents so A could claim reimbursement under indemnity insurance.
Critics say clinics are going too far with loophole care, such as using manual therapy—applied to musculoskeletal (muscle and bone) disorders—to treat gynecological itching. Although manual therapy has been designated as a managed benefit, detailed clinical standards have not been established, allowing irregular medical practices to continue.
According to the insurance industry on the 7th, a partial amendment to the Enforcement Decree of the National Health Insurance Act to incorporate into health insurance certain non-covered services that induce overtreatment, such as manual therapy and percutaneous epidural neuroplasty, was promulgated and took effect on the 19th of last month.
Manual therapy is classified as a non-covered service, so fees vary by hospital. Because most patients are reimbursed through indemnity insurance, many hospitals recommended and performed unnecessary manual therapy and pocketed insurance payouts. When a particular hospital collects a lot of insurance money, premiums for other policyholders go up.
Health authorities expect that designating manual therapy as a managed benefit will unify fees and clinical standards and reduce overtreatment. But with no detailed standards on which conditions warrant manual therapy and how it should be performed, some hospitals are administering it for symptoms not medically validated.
The insurance industry argues that because the benefits of manual therapy are limited, clinical standards should be strict. According to a medical technology reappraisal that the National Evidence based Healthcare Collaborating Agency (NECA) released in Dec. last year, manual therapy was deemed to lack sufficient grounds for use outside musculoskeletal disorders of the spine, upper limbs and lower limbs.
The Ministry of Health and Welfare plans to announce detailed standards for fees and clinical criteria through follow-up procedures. An insurance industry official said, "The government should swiftly announce the detailed implementation methods for managed benefits and strengthen regulations on abnormal insurance claims."