Non-covered costs are highest in orthopedic and manual therapy

(Health Korea News / Yu Ji-in) Last September, orthopedics had the highest non-covered costs among treatment subjects, and manual therapy had the highest among items. On the 20th, the Ministry of Health and Welfare and National Health Insurance Service released the results of the analysis of the ‘2023 Second Half Non-covered Reporting System’ data containing these contents to the press.

The non-covered reporting system is a system in which medical institutions report non-covered treatment details, etc. to understand the status of non-covered treatment and guarantee the public’s right to know about non-covered treatment information and right to choose medical care. In the second half of 2023, 4,078 medical institutions above the hospital level reported treatment details (unit price, frequency, disease name, etc.) for 594 non-covered items for September 2023.

In March of this year, the reporting target institutions were expanded to all medical institutions including hospitals, and the number of reporting items was also expanded to 1,068. The results of this analysis are from the analysis conducted for hospitals for the first time in the second half of last year.

According to the analysis of non-covered medical expenses report data for the second half of 2023, the total medical expenses for 594 items at hospital-level medical institutions in September 2023 amounted to KRW 422.1 billion. By type, hospitals were the largest at KRW 193.8 billion (45.9%), and by treatment subject, orthopedic surgery had the highest medical expenses at KRW 117 billion (27.7%).

(Non-covered medical expenses by type) (Unit: location, number of cases, ten thousand won)

(Non-covered medical expenses by medical department) (Unit: 100 million won)

The size of medical expenses by item was the largest for manual therapy at KRW 49.4 billion (11.7%), followed by single-room superior ward fees at KRW 45.1 billion (10.7%) and spine-lumbosacral MRI at KRW 18.7 billion (4.4%). The top 10 items accounted for 45.3% of the total non-covered medical expenses.

The top 10 items are ▲manual therapy ▲single-room premium ward fee ▲lumbosacral MRI, ▲dental implants ▲extracorporeal shock wave therapy ▲percutaneous epidural neurolysis ▲musculoskeletal knee joint MRI ▲musculoskeletal shoulder joint MRI ▲robot-assisted prostate cancer surgery ▲robot-assisted thyroid cancer surgery, etc.

(Non-covered medical expenses by item) (Unit: 100 million won)

The government stated, “As a result of this analysis of non-covered treatment reports from hospitals and above, some non-covered treatments, such as manual therapy, are linked to actual loss insurance, showing a tendency toward excessive treatment,” and “We plan to strengthen non-covered treatment management, such as establishing measures to manage non-severe, excessive non-covered treatments that burden the public’s medical expenses and health insurance finances.”

In accordance with the first implementation plan for medical reform announced on August 30, we will support rational medical choices for consumers by strengthening non-covered monitoring and expanding information provision, and promote overall non-covered standardization by developing non-covered standard treatment guidelines, standard names, and codes by collecting opinions from the medical field.

By strengthening non-covered monitoring, we are now monitoring total medical expenses by disease, surgery, and patient characteristics, as well as the corresponding medical institutions, rather than previously reporting only prices for non-covered items.

The scope of information provision for non-covered items will be expanded to disclose ▲medical expenses (total medical expenses, detailed medical expenses information by type and region, detailed analysis information (purpose, context, medical expenses increase rate, etc.)), ▲safety and efficacy evaluation results, ▲alternative treatment methods, etc.

For non-serious non-covered treatments with a clear tendency for abuse, such as manual therapy, if medical necessity is low, we will consider restricting concurrent treatment benefits, and we will also consider excluding from non-covered items any technologies that are ineffective or have safety issues through periodic re-evaluation of medical technology and verification of effectiveness.

Kwon Byeong-gi, the Essential Medical Support Officer at the Ministry of Health and Welfare, said, “We will analyze the data collected through the reporting system to provide information that is helpful for the people’s actual use of medical care, and continue to strengthen non-covered treatment monitoring, such as expanding the non-covered treatment reporting system,” and “We will establish specific implementation plans through sufficient discussion with experts, including the medical community, regarding the non-severe and excessive non-covered treatment management plan presented in the first implementation plan for medical reform.”

The integrated non-covered care portal, where non-covered care-related information can be easily viewed at a glance, is scheduled to open in December.

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