As the medical community reviews a plan to cap indemnity insurance coverage for extracorporeal shock wave therapy at 12 sessions a year to quell overtreatment controversy, data show that the share of patients who actually received treatment 12 times or more a year falls short of 5%.
An analysis by Yonhap News on the 31st of last year's indemnity insurance claims from the five major non-life insurers—Samsung Fire & Marine Insurance, Hyundai Marine & Fire Insurance, DB Insurance, KB Insurance, and Meritz Fire & Marine Insurance—found that the share of people who used extracorporeal shock wave therapy 12 times or more a year was just 4.6%.
By number of sessions, fewer than five accounted for 78.5%, making up the vast majority. That was followed by five to fewer than eight at 11.2%, eight to fewer than 10 at 3.5%, and 10 to fewer than 12 at 2.1%.
Extracorporeal shock wave therapy is cited as a representative non-covered overtreatment item. As of March last year, related medical expenses totaled 75.3 billion won, the second largest after manual therapy.
In response, the Korean Medical Association Organization moved to act, preparing guidelines to limit treatment to once a week and 12 times a year. However, critics note the policy may lack effectiveness given that actual high-frequency users are few.
The insurance industry worries that a simple cap on the number of sessions could backfire. Medical institutions may respond by raising the per-session price or by reconfiguring treatment packages. Costs for extracorporeal shock wave therapy vary widely by institution and by whether care is outpatient or inpatient.
Looking at actual billed amounts, 70,000 won to under 100,000 won was most common at 1,373,965 cases (35.8%), but 50,000 won to under 70,000 won at 1,105,621 cases (28.8%) and under 50,000 won at 713,646 cases (18.6%) were also significant. Amounts of 100,000 won to 150,000 won were 11.8%, 150,000 won to 200,000 won were 3.5%, and over 200,000 won were 1.5%.