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Cancer patients have high expectations for new anticancer drugs. In the hopes of a full recovery, there are many cases where they have to bear the burden of millions of won at a time, but it turned out that each hospital had different health insurance coverage for these expensive new drugs. What's more, the government's measures made the patients even more angry.
Reporter Park Byung-il reports.
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Kim Ye-ji, a 34-year-old housewife, was diagnosed with stage 2 breast cancer in 2018.
After receiving several doses of anti-cancer drugs, all the cancer masses disappeared.
[Kim Ye-ji (pseudonym): It's completely gone... You said that you are completely in remission.]
However
, you had
to pay 20 million won each, millions of won per medication.
This is because the new drug that Kim received is not covered by health insurance.
On the other hand, 72-year-old Mi-Ja Choi, who was diagnosed with biliary tract cancer, is receiving health insurance coverage even though she used a similar anti-cancer drug.
[Seo Yu-jin (pseudonym)/Daughter of cancer patient: I pay about 170,000 won per episode. If you don't get insurance, it's 5.8 million won at a time.] The
reason some people get insurance benefits and others don't is because of the 'new comprehensive
fee
system'.
The new comprehensive fee system is a system that combines the comprehensive fee system, in which the health insurance pays a predetermined amount for basic services such as hospitalization and pharmaceutical expenses, depending on the disease, and the fee-for-service system, in which the insurance pays out a doctor’s surgery or procedure after reviewing each act. no see.
It was introduced to prevent over-treatment or poor treatment and is being pilot-operated in 98 hospitals.
What happened?
Expensive anticancer drugs are originally subject to insurance reimbursement review.
However, some new drugs were omitted from this review list due to the government's mistake.
Then, some pilot hospitals applied for insurance benefits as an inclusive fee by putting them in the general drug cost, and the Health Insurance Review and Assessment Service could not filter it out, so cancer patients only had to pay 5%.
[Kim Yun/Professor, Seoul National University College of Medicine: (Pilot) Hospitals have been prescribing such expensive drugs to patients who are not covered by health insurance, and the HIRA has continued to operate the system without knowing that…
.] As a result
, cancer patients flocked to some pilot hospitals, and pilot hospitals using this system to attract cancer patients were created.
The number of patients who took anticancer drugs at the new comprehensive fee-for-service pilot hospital surged, and the amount of insurance claims increased that much.
Then, the government announced that from next year, pilot hospitals would also review each anticancer drug and decide whether to pay insurance.
Cancer patients reacted immediately.
[Lim Mi-sook (pseudonym)/pancreatic cancer patient: I pay 300,000 won (for a single dose), but they say that insurance will not be available from January next year.
Then I had to pay 6-7 million won.
It's getting harder to get treatment now.] The
government changed its stance again as the members of the National Assembly began to criticize them.
[Ryugeunhyeok / Health and Welfare Vice: If you're being received and applied the treatment of my burden of 5% can be treated at own expense at the same level as the previous next year]
, but cancer patients If you change the resistance blossomed in sseudeon about insurance A situation in which they protest again saying that they will not be able to receive .
In the end, it became difficult to avoid criticism that the government failed to carefully design the new comprehensive fee-for-service system from the beginning, causing confusion and entertainment and raising the anger of cancer patients.
(VJ: Yoon Taek)