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The health insurance coverage rate in 2019, the third year of ‘Moon Jae-in Care’, was 64.2%. The coverage rate itself is the highest since 2010 as a result of the intensive investment of health insurance finances in medical expenses for serious illnesses or children and the elderly, who have a high burden of medical costs. However, it is assessed that achieving the goal of ‘70% by 2023 ‘at the time of’ Moon Jae-in Care ‘was practically difficult.
On the 29th, the National Health Insurance Corporation announced the results of the “ 2019 Health Insurance Patient Medical Expenditure Survey ”. Last year, the health insurance coverage rate was 64.2%, an increase of 0.4 percentage points over 2018 (63.8%). The statutory copayment rate was 19.7% and the default copayment rate was 16.1%.
The health insurance coverage rate is the percentage of total medical expenses (excluding general medications, plastic surgery, prosthetic expenses for cosmetic purposes, medical treatment expenses for health promotion purposes, etc.) paid by the Corporation Health Insurance (excluding medical benefits, industrial accidents, automobile insurance, etc.) ser – estar.
If the medical insurance patients incurred a total of 1 million won last year, this means that the medical insurance paid 642,000 won and the patient paid 358,000 won. Of the patient burden, 197,000 won was an out-of-pocket cost under the health insurance system and 161,000 won was an “unpaid” medical fee that was not covered by health insurance.
By type of medical institution, general hospitals for the elderly with many critically ill patients increased 0.8 percentage points to 69.5% and general hospitals increased 1.5 percentage points to 66.7%. The coverage rate above the hospital level also increased by 1.6 percentage points to 64.7%.
The coverage rate of the ’30 major diseases with high cost per person ‘, such as leukemia and pancreatic cancer, was the highest ever at 81.3%, and even if the scope was expanded to ’50 major diseases’, was high up to 78.9%. It is interpreted as a result of government measures to strengthen health insurance coverage by incorporating ‘non-payment necessary for treatment’ into health insurance, focusing on serious and high-cost illnesses.
On the other hand, the coverage rate of local clinics decreased by 0.7 percentage points to 57.2%. The unpaid direct disbursement rate increased by 1 percentage point to 23.8%. To maximize profits, local clinics with fewer health insurance funds are increasing their unpaid care, allowing them to set their own prices.
By age group, the coverage rate for ‘under 5 years of age’, which is a medically vulnerable group, was 69.4%, a decrease of 0.1% compared to the previous year, and ’65 years and over ‘ it was 70.7%, the same as the previous year. In particular, the coverage rate for children under 1 year of age was 79.4%, 5.2 percentage points more than last year.
Korea’s health insurance coverage rate was 63.6% in 2010, 63.0% in 2011, 62.5% in 2012, 62.0% in 2013, 63.2% in 2014, 63.4% in 2015, 62.6% in 2016, 62.7% in 2017 and 63.8% in 2018. It stayed at the low 60% for a long time.
Since the coverage rate lagged far behind the OECD average of 80%, the government set a goal of increasing the coverage rate to 70% by 2023. The required budget from 2017 to 2022 is 31.6 trillion won. However, it is expected to be difficult to reach 70% last year, as the guarantee rate rose only 0.4 percentage points.
Yu hwan-gu reporter [email protected]
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