[Actually] President Yoon "a waste of 20 trillion won"

Recently, the Moon Jae-in government's medical policy to raise the health insurance coverage rate to 70%, the so-called 'Moon Jae-in Care', has been on the cutting board.

The beginning is the remarks of President Yoon Seok-yeol's cabinet meeting on the 13th.

It is urgent to normalize health insurance, which is the last bastion to protect public health.

Over the past five years, the government has poured over 20 trillion won into strengthening insurance coverage, but as the government neglects medical abuse and health insurance free riding, the burden is being passed on to the majority of the people.

The popular populist policy is bound to ruin the finances, undermine the foundation of the national health insurance system, and eventually force the people to make great sacrifices.

- On the 13th, President Yoon Seok-yeol's remarks at the cabinet meeting

It was read as a de facto declaration of scrapping of 'Moon Jae-in Care'.

The ruling party is also stepping in.

The power of the people is criticizing Moon Jae-in care every day.

It is not very different from President Yoon's claim.

It is said that finances are being wasted due to Moon Jae-in's care, that blindly trying to increase the guarantee rate only made moral hazard worse, and in the end, the damage was left to the people.

If so, how did the money for Moon Jae-in's care come out like this?

Can we really see that 20 trillion won was wasted?

I think you should take a closer look at the details.

The fact of SBS fact check was verified by the team.

Enlarge Image

.

Detailed analysis of KRW 20 trillion

Moon Jae-in Care is a policy to alleviate the national medical cost burden by increasing the health insurance coverage rate and lowering the burden of hospital expenses on households.

It began in August 2017 when President Moon Jae-in announced the 'Health Insurance Coverage Reinforcing Policy', which aims to lower the average burden of medical expenses for all citizens by 18% by 2022.

Since then, in December 2018, as the National Health Insurance Act was revised, the plan is still in progress under the name of 'The 1st Comprehensive Health Insurance Plan'.

Enlarge Image

Moon Jae-in Care began when President Moon Jae-in visited Seoul St. Mary's Hospital on August 9, 2017 and announced the 'Health Insurance Coverage Reinforcing Policy', which aims to lower the average burden of medical expenses for all citizens by 18% by 2022.

SBS In fact, the team secured the data prepared by the National Insurance Corporation.

After the implementation of Moon Jae-in Care, this is money that was not originally spent, but it is specific data on the health insurance finances that were additionally invested.

President Yoon Seok-yeol said he poured '20 trillion won' into Moon Jae-in care.

As President Yoon said, for the five years from July 2017 to June this year, the additional finances were analyzed at about 20 trillion won.

Exactly 21,261.6 billion won.

Listed in descending order of expenditure.

Enlarge Image

The most expended item in Moon Jae-in Care was the project to alleviate the insurance coverage for severe drug expenses.

This is a policy that allows treatment of rare diseases costing up to hundreds of millions of won to be applied as health insurance.

This is over 4 trillion won.

Below are the out-of-pocket caps.

This is a system in which health insurance subscribers pay the excess amount from the health insurance finances if the total amount of their annual contributions exceeds a certain amount.

Introduced in July 2004, Moon Jae-in Care has expanded its scope.

From January 2018, the upper limit on medical expenses for health insurance for the bottom 50% of the income bracket was lowered to 10% of annual income.

Enlarge Image

If you look closely, you can see that there are many policies to reduce the burden on the vulnerable.

Representatively, more than 900 billion won was additionally spent on support for infertile women.

This can be classified as a policy that increases the fertility rate along with health insurance coverage.

The same goes for child medical expenses.

In Korea, where the elderly poverty rate is high, the budget to support the elderly who desperately need medical expenses is also noticeable.

738.2 billion won for implants for the elderly, 678 billion won for outpatient treatment for the elderly, and 479.6 billion won for dentures for the elderly.

From now on, it is the realm of judgment.

From a reasonable point of view, the budget does not seem to be a big problem.

In fact, the above medical expense details were partially disclosed during this year's parliamentary audit.

At the time, the opposition party expressed that “Moon Jae-in Care reduced medical expenses by 20 trillion won,” while the government and the ruling party called it “financial collapse and waste of blood tax.”

Paradoxical.

Moon Jae-in Care 'moral hazard' scale?

Now the problem will be the 'moral hazard' part.

This is the part that critics of Moon Jae-in Care mainly point out.

If the level of moral hazard due to Moon Jae-in Care is serious enough to offset the effect of strengthening protection, the government and ruling party's awareness of the problem of 'abolition of Moon Jae-in Care' can be seen as valid.

On the other hand, if the level is not at a level that shakes the great principle of strengthening protection, it can be said that it is sufficient to supplement the system rather than completely abolish it.

The most frequently discussed items are ultrasound and MRI.

This is the current status of total medical expenses for this part.

Enlarge Image

In 2018, it was only KRW 137.8 billion for ultrasound and KRW 51.3 billion for MRI, but last year, KRW 1.2537 trillion for ultrasound and KRW 593.9 billion for MRI surged to KRW 1.8476 trillion.

As a result, usage and overall medical costs have also increased.

However, it is natural that demand will increase as protection is strengthened.

Healthcare services are highly price elastic.

Even a small drop in price can significantly increase demand.

It is difficult to confirm with the above data whether this is due to moral hazard or whether the medical services that have been needed by the people have become commonplace.

Enlarge Image

In fact, the team decided to look at the <Health Insurance Financial Management Status Audit Report> announced by the Board of Audit and Inspection last July to ascertain the scale of the moral hazard more clearly.

At the time, the Board of Audit and Inspection pointed out that moral hazard was occurring in various items of Moon Jae-in Care.

The Board of Audit and Inspection announced that several problems arose while pushing for reimbursement for ultrasound and MRI.

For example, when turning an item that is not covered by insurance into an item that is covered by insurance, the government compensates hospitals for some loss, but the Board of Audit and Inspection wrote that the compensation was large.

As the unit price of ultrasound and MRI goes down, hospitals are still assuming losses and covering losses even though they have made quite a bit of money due to increased frequency of treatment.

The Board of Audit and Inspection recalculated the compensation scale from October 2018 to December last year using 12 university hospitals as a sample, and estimated that 20.1 billion won was excessively paid.

It is estimated that excessive loss compensation was made by KRW 18.72 billion for brain MRI from October 2018 to December 2021 and KRW 1.44 billion for head and neck MRI from May 2019 to December 2021.

- Board of Audit and Inspection, <Health Insurance Financial Management Status Audit Report>, July 2022, p. 165.

However, it is difficult to say that it is such a large level compared to the total amount of expenditure.

The Board of Audit and Inspection also issued a 'notice' action to prepare complementary measures.

Rather, it is noticeable that the budget was excessively spent due to excessive treatment of ultrasound and MRI.

The Board of Audit and Inspection wrote that as a result of sample inspection of 5 ultrasound scans and brain MRIs, including the upper abdomen, cases worth 160.6 billion won were suspected of violating the salary standard.

Enlarge Image

However, limitations of the analysis are also explained.

It was only 'estimated' that about 160.6 billion won was in violation of the regulations, but it was added that the whole cannot be seen as unfair claims.

In other words, it is read as saying that there are difficulties in measuring the level and level of clear moral hazard.

The Board of Audit and Inspection also wrote that if a person who subscribed to private insurance receives a refund from the National Health Insurance Corporation under a self-pay cap, there is also a controversy over double receipt of the money from the insurance company.

In 2020, about 660,000 private indemnity medical insurance subscribers received 585.3 billion won in reimbursement, and the total amount of reimbursement received by indemnity medical insurance subscribers from 2019 to 2020 was confirmed to be KRW 1.701 trillion. .

It is estimated that the double receipt of refunds and private loss insurance payments will reach up to KRW 500.8 billion as of 2020.

- Board of Audit and Inspection, <Health Insurance Financial Management Status Audit Report>, July 2022, p. 200.

However, the controversy over double receipt of private insurance is also a chronic problem that has been pointed out since the National Health Insurance was designed.

The out-of-pocket cap is also a policy that has been in place since 2004.

It can be seen that various parts such as design problems of private insurance companies are intertwined in a complex manner rather than simply a problem unique to the self-pay cap system.

As a result, as the Board of Audit and Inspection itself admits, it was not easy to determine the specific scale of moral hazard related to Moon Jae-in Care and the amount of budget waste.

This part seems to require more systematic research. 

Data that refutes or supports Moon Jae-in Care

Since President Yoon Seok-yeol's remarks, numerous debates have continued in our society regarding the strengthening of security, and numerous data are being mobilized to support our own logic.

People who criticize Moon Jae-in Care worry about our health care finances.

Financial issues are becoming a key argument.

In fact, the team received the financial balance status for the last 5 years from the Health Insurance Corporation.

Enlarge Image

It is true that after Moon Jae-in Care, the financial deficit of the health insurance has increased.

The Health Insurance Corporation wrote in an answer to the question of the SBS Truth Team, "In 2018, insurance benefits increased due to the full-scale implementation of measures to strengthen protection, and turned into a deficit."

The transition to surplus since 2020 was also a temporary phenomenon, saying, "The spread of Corona 19 has greatly reduced insurance benefits for respiratory and infectious diseases and has improved."

Looking closely at the table above, a significant increase in insurance premium income means that premiums have risen accordingly. In particular, the fact that the share of government subsidies has increased by nearly KRW 3 trillion over the past five years also implies that the national fiscal burden may increase in the future. are doing

Looking at the long-term financial outlook for health insurance for the next 40 years predicted last year by the Ministry of Health and Welfare and the National Health Insurance Service, it was analyzed that the cumulative deficit in 2040 will reach 678 trillion won.

On the other hand, those who support Moon Jae-in Care are based on our health insurance coverage rate.

By OECD country standards, the guarantee rate is too low.

To compare our health insurance coverage rate with other countries, we need to look at the 'public finance ratio' to total medical expenses.

The public finances in OECD statistics mean the sum of health insurance and government support.

In fact, the team analyzed and ranked the health insurance coverage rate by country as of 2020 on the OECD statistics site.

Enlarge Image

As of 2020, when all OECD member countries' statistics were secured, Korea ranked 36th out of 38 countries with 62.6%, the lowest level.

For reference, in the case of the United States, according to OECD statistics, until 2013, it was at the bottom of the OECD country at 40% level, but after 2014, when Obama Care was implemented, it was analyzed that it had nearly doubled to the 80% level.

Countries with economies larger or similar to Korea are marked separately with their national flags.

Germany 85.1%, USA 84.8%, France 84.7%, Japan 83.4%, UK 82.8%, Italy 76.1%, Canada 75.0%.

They are also higher than us.

It is also a 'true' that Korea's health insurance coverage rate is very low.

Looking at this data alone, Korea's medical expenses are still burdening households.

As well as stabilizing public livelihood, as the burden of medical expenses is linked to the birth rate, it would not be wrong to argue that Korea, a country with the worst birth rate, should prioritize strengthening the health insurance coverage rate.

Enlarge Image

It is virtually impossible to balance financial stability and health insurance coverage.

At what level should we adjust our financial stability and, conversely, at what level should we adjust the health insurance coverage rate, and what should be prioritized?

However, the reality is always a fight.

I don't know how helpful the current reality of political slogans, such as financial collapse, populism, erasure of Moon Jae-in, and the controversy over the 70,000 won insurance premium of Mrs. Kim Kun-hee, will help shape the future of medical care in Korea.

Enlarge Image

The SBS truth team verified President Yoon Seok-yeol's remarks that "the health insurance finances were ruined by wasting 20 trillion won on Moon Jae-in care."

In fact, as a result of the team securing and analyzing the specific details of 20 trillion won, it was determined that there was no major problem from the point of view of necessity.

The problem is the level of moral hazard.

If the moral hazard of Moon Jae-in Care is serious enough to offset the effect of strengthening the guarantee, the government and ruling party's awareness of the problem can be considered valid.

The Board of Audit and Inspection itself acknowledged the limitations of its analysis.

As there is no clear data on this, the SBS fact-finding team decided to reserve judgment on President Yoon's remarks.

Words like 'waste' or 'pain' are difficult to be fact-checked in the realm of political interpretation.

However, in fact, the team has presented all the objective data that people who support or refute Moon Jae-in Care often cite.

I hope viewers can see this data and judge for themselves.