The National Health Insurance Service is accepting as a fait accompli that it will shift to a deficit this year after years of surpluses. Although it still has as much as 30 trillion won in reserves and is not immediately facing a fiscal crisis, the service sees this period not as a time to "hold out," but as a time to change the structure.
On Jan. 12, National Health Insurance Service President Jeong Giseok said at a work briefing for public institutions under the Ministry of Health and Welfare, "After about five years, the surplus trend has ended and a deficit this year is almost certain," adding, "We may be fine for a few years because we have reserves, but we must find a new breakthrough in the meantime."
Jeong stressed that strengthening expenditure control is inevitable before raising premiums. Jeong said, "In a structure where we collect and spend premiums, no one wants premium increases," and added, "As the sole insurer with the responsibility to manage finances, we will look more closely and precisely at expenditure."
To that end, the service will manage volumes of care centered on the insurance care promotion team "NHIS-CAMP." Jeong said, "Even if adjustments are made at the review and assessment stage, it is not easy to control the 'amount' of care after the fact," adding, "For example, under the current system it is hard to properly distinguish between cases where blood tests are done daily and cases where they are done every other day."
Using big data, the service has already built a dashboard that shows prescription patterns at a glance by hospital, disease, and doctor. Jeong said, "When you analyze it as a normal distribution, there are points that look like completely isolated 'islands,'" and added, "We believe some degree of control is necessary over areas that are clearly excessive." However, Jeong added, "Careful judgment is needed on how far to see the physician's unique domain of practice as subject to management."
Basic work to overhaul the fee schedule structure is also underway. Through a cost analysis team, the service has largely completed cost analyses for major services and procedures. Jeong said, "Not only large hospitals but also private clinics participated, and we built data based on ABC cost analysis," adding, "We have already secured data for highly profitable areas such as clinical tests and general specimen tests."
Jeong emphasized that these data should be used in policy decisions. "Only with appropriate compensation can physicians in essential specialties return to the field," Jeong said. Jeong added, "This year, internal medicine barely filled its quota of applicants, and there was almost no interest in the provinces," and said, "If this situation accumulates, essential care will inevitably become more difficult."
Regarding the fee contract scheduled for May, the stance is to continue the policy of supporting essential care using the conversion index. Jeong said, "Last year we raised the conversion index by 2% and allocated part of it to essential areas such as consultation fees," adding, "Even if there is no major change, we will make up for it so that the specialties that diligently see patients do not suffer a relative disadvantage."