The National Health Insurance Service failed to pay on time about 220 billion won in medical treatment fees and drug costs claimed by hospitals and pharmacies for medical aid patients due to a budget shortfall. The funding fell short as the number of medical aid recipients grew faster than the government initially expected. With delays in paying medical aid costs recurring, some note that the financial burden on the medical field is mounting again.
According to the Ministry of Health and Welfare on the 31st, the insurer is delaying payments for treatment in some regions, including Seoul, Incheon, Gyeonggi, North Gyeongsang and South Chungcheong, due to a shortage in the medical aid fund. The nonpayment began last month, according to reports.
The ministry explained that a sharp increase beyond projections in the number of medical aid recipients was the direct cause. Authorities initially expected 1.56 million recipients this year, but the actual number reached 1.63 million as of last month, up 70,000.
The ministry said, "Large wildfires and heavy downpours increased the number of disaster victims, and as of this year the support obligation standards that factor in children's income and assets were significantly eased, which drove the recipient count higher than expected."
Previously, 30% of a son's income and 15% of a daughter's income were deemed to support parents, but starting this year both sons and daughters are set at 10%. From next year, children's income and assets will not be reflected at all.
Medical aid is a system in which the government covers most medical expenses for low-income people who have difficulty enrolling in the National Health Insurance. As of November this year, 1.63 million people, including basic livelihood guarantee recipients, disaster victims, national merit honorees and North Korean defectors, are receiving medical aid benefits, and annual expenditure amounts to about 12.4 trillion won.
Medical aid is divided into Type 1 and Type 2. Type 1 beneficiaries have all inpatient treatment costs waived and pay only 1,000 to 2,000 won for outpatient visits. Type 2 beneficiaries pay 10% of inpatient costs and 15% of outpatient costs (1,000 won at neighborhood clinics).
Most funding comes from taxes, with the central government and local governments typically sharing the burden at an 8-to-2 ratio. After the government forecasts the annual number of medical aid recipients and sets the budget, the insurer pays hospitals and pharmacies for their treatment and drug claims.
This is not the first time medical aid costs have gone unpaid. In the past, the insurer failed to pay medical aid expenses on time amounting to ▲ 29 billion won in 2015 ▲ 294.1 billion won in 2016 ▲ 438.6 billion won in 2017 ▲ 178.1 billion won in 2018. After the government injected a large amount of budget funds, the issue stopped, only to recur for the first time in five years.
The government plans to use next year's medical aid budget to fully pay the delayed amounts by mid-January. Payments in Seoul, Incheon and Gyeonggi are set to be made after Jan. 14, and in North Gyeongsang and South Chungcheong after Jan. 22. However, it will not pay interest for the delay. Earlier, the Anti-Corruption & Civil Rights Commission recommended to the ministry in 2008 that it pay annual interest of 5% if medical aid expenses are delayed by 10 days or more.