As manual therapy shifted to managed benefits, hospitals and clinics are increasing or raising prices for renal spray therapy and extracorporeal shock wave therapy. Critics say that although manual therapy was regulated to curb leakage in indemnity insurance, a so-called "balloon effect" is emerging in which the leakage of insurance payouts is expanding to other non-reimbursable items.
According to the insurance industry on the 8th, since managed benefits for manual therapy took effect last month, the pattern of claims for indemnity insurance has been changing rapidly, centered on renal spray therapy and extracorporeal shock wave therapy. Renal spray therapy refers to a treatment that alleviates muscle pain by spraying a cooling spray, while extracorporeal shock wave therapy refers to a method that induces vascular regeneration by directing high-energy shock waves from outside the body to areas of pain or lesions.
The General Insurance Association of Korea analyzed indemnity insurance claims from seven non-life insurers (Meritz, Hanwha, Heungkuk Metaltech, Samsung, Hyundai, KB, DB) and found that the average daily claim amount for renal spray therapy during the eight business days from July 1 to 10 was 345 million won, about three times the amount during the same period in June (June 1–11, 113 million won). The number of claims rose 73.2%, from 2,666 to 4,618, and the amount claimed per case increased 77%, from 42,257 won to 74,813 won.
The industry notes that cases recommending renal spray therapy instead of manual therapy are increasing. In fact, at one hospital in the capital area, a patient who paid 160,000 won for manual therapy in June received renal spray therapy for the same amount after managed benefits took effect. At another hospital, a patient who had received manual therapy for 220,000 won received renal spray therapy worth 150,000 won after the system was implemented. As unit prices for treatment have risen, medical expenses by institution now vary widely, from at least the 1,000-won range to as high as 500,000 won.
For extracorporeal shock waves, the balloon effect is appearing in the form of rising unit prices. With the self-correction guidelines prepared by the Korean Medical Association Organization now applied, the number of extracorporeal shock wave treatments has been limited since this month to six per body part and a maximum of 12 per year. In the first eight business days of July, when the system was implemented, the average daily claim amount and the number of claims were tallied at 623 million won and 5,929, respectively, down 29.7% and 41.8% from the previous month. In contrast, the amount claimed per case rose 20.9%, from 86,874 won to 105,011 won.
The government has introduced managed benefits for manual therapy and applied self-correction guidelines to extracorporeal shock wave therapy, but it has not yet presented separate management measures for other non-reimbursable items such as renal spray therapy. An insurance industry official said, "If the balloon effect of managed benefits continues, a second manual therapy that causes leakage of indemnity insurance payouts could emerge," adding, "It would be desirable to bundle non-reimbursable treatments for pain relief and designate them all at once as managed benefits."