The Health Insurance Review & Assessment Service (HIRA) will fully launch a "full-cycle management system for non-reimbursable care," managing each stage from information disclosure to post-use reassessment. The move is aimed at addressing issues such as price disparities for certain non-reimbursable items and overuse driven by the impact of indemnity insurance.
HIRA said on the 9th it will promote a system that manages non-reimbursable care by dividing it into information management, use management, and post-management.
Until now, non-reimbursable care has been run as an area of provider autonomy, but wide price differences by item and increased medical use linked to indemnity insurance have raised concerns about the public's medical cost burden.
HIRA plans to no longer leave non-reimbursable care outside the scope of national health insurance, but to include it within a management system that reviews the entire process of medical use.
First, at the information management stage, it will improve price disclosure for non-reimbursable items and the procedures for prior explanation and consent. It plans to standardize names, codes, and criteria for services so that prices and details can be easily compared by medical institution.
At the use management stage, it will select non-reimbursable items that require oversight and establish criteria for appropriate use. The conversion of manual therapy to managed benefit, implemented on the 1st, is the first case.
After managing manual therapy, HIRA also plans to check for the occurrence of a "balloon effect," where use shifts to other non-reimbursable items such as extracorporeal shock wave therapy.
It will also analyze the linkage structure between national health insurance and indemnity insurance, and changes in non-reimbursable use patterns through the "task force to improve the non-reimbursable management system" established in July.
In the post-management area, it will reassess the effectiveness and safety of non-reimbursable items and, if necessary, consider adjusting them to benefit, selective benefit, or managed benefit, or removing them.
Currently, medical services under national health insurance are classified into 7,203 benefits, 171 selective benefits, 3 managed benefits, and a non-reimbursable area. HIRA plans to link these areas within a single management system going forward.
Hong Seung-gwon, president of HIRA, said, "The goal of managing non-reimbursable care is not to restrict the public's right to choose medical services, but to guarantee necessary services while reducing excessive use and unreasonable burdens," adding, "We will move toward a system that integrates benefit and non-reimbursable care management at the patient level."