<Anchor> It
is a friendly economic time that selects and informs only the information necessary for life. Today (12th), I will be with reporter Kim Hye-min. Reporter Kim Today we are talking about indemnity insurance. But why is it that many people have to pay a lot of insurance premiums because there are a lot of people who are over-treating with indemnity insurance? However, it will be difficult to conduct such excessive treatment in the future. Here's a view.
<Reporter>
Yes. Indemnity insurance is so popular that it is called the second health insurance. Because there are many people receiving over-treatment, the majority of people who receive treatment honestly suffer losses.
The first-generation indemnity insurance, which provides virtually unlimited access to uninsured medical care, has increased its premium by around 20% for two consecutive years.
Another increase in the next year is inevitable. In addition, as the coverage of indemnity insurance was gradually reduced and released, 4th generation indemnity insurance is now available.
In fact, the insurance industry should block people who receive over-treatment, but rather than that, it happened because it was trying to make up for this loss by raising the overall premium.
So, this time, the financial authorities and the insurance industry have launched a task force team to prevent reckless unpaid care and overtreatment.
<Anchor>
Now, the TF has finally started to operate. So, I'm a bit curious as to which cases are overtreatment.
<Reporter>
To make it easier to understand, let's take a concrete example. A 15-year-old middle school student received 122 manual therapy sessions in the past three years and received 28 million won in insurance money.
In fact, manual therapy is a medical treatment for people with musculoskeletal disorders, and this middle school student did not have any related diseases.
The insurance industry explained, "At some medical institutions, when adolescents receive manual therapy, their height or body shape is corrected. These exaggerated advertisements are being made."
In particular, it is said that the number of cases where manual treatment is performed in dermatology or dentistry regardless of medical standards is increasing.
When some of the insured indiscriminately receive actual loss insurance, insurance companies have repeatedly raised the premiums of a large number of well-behaved insurers, claiming that the loss ratio is high.
<Anchor>
Reporter Kim, are there any other items with a lot of overtreatment besides manual therapy?
<Reporter>
There are people who get over-treated without knowing it, but there are also people who get a recommendation from the hospital without knowing it, and then get frustrated.
So, there are overtreatment items that the TF team has found so far, and it would be helpful to know this in advance.
First, on a tired day or the day after drinking a lot, nutritional supplements or vitamin injections are often administered at the hospital.
From now on, it will be recognized only when treatment is performed to see the efficacy of drugs approved by the Ministry of Food and Drug Safety. Exceeding this permit standard is considered overtreatment.
Also, as mentioned earlier, this applies to cases where manual therapy is repeatedly performed even if it is not a musculoskeletal disorder, or when multifocal cataract surgery is performed multiple times in the age group under 65 years of age.
It is also included when I have multiple thyroid radiofrequency ablation and corn cryocoagulation. What these treatments have in common is that insurance payments have increased abnormally in recent years.
That said, there are a lot of people who don't need treatment. And it is a plan that the TF team will continue to find additional items for this over-treatment.
<Anchor>
But reporter Kim, if you see overtreatment, a patient goes to the hospital and says, "Please do this to me." Rather, the hospital offers it first. There is a lot of over-treatment like this, saying, “Please get treatment because this is indemnity insurance.” In the end, I think it is a situation where hospitals are just setting things up. Then, from the point of view of the patient, it is necessary to accurately identify and know what is overtreatment. Then, when will this be implemented?
<Reporter>
This is not going to be implemented right now. By the end of next month, the TF team will find out the items of overtreatment. We also plan to draft how to strengthen insurance review.
After that, after collecting opinions from experts and consumers, we are planning to implement it from the beginning of next year.
When this policy is implemented, in principle, the purpose of treatment must be confirmed through objective medical grounds, and treatment must be performed within the scope permitted by the health authorities before insurance payments are paid.
Failure to do so may result in denial of insurance payments. Actually, this should have been implemented sooner, but I feel it's a little late.
There is still some time left until the regulations are implemented, but from now on, it is necessary to make it a habit to avoid receiving excessive treatment and unnecessary non-pay items as much as possible.