[Op-Ed] Medical Fee Readjustment Is Inevitable

Debate over adjusting medical fees continues. Korea’s health and medical indicators are among the best in the world, yet its medical fee levels are dismal. According to the OECD, when U.S. fees are set at 100 and countries’ medical fees are compared relatively, Korea stands at 48. That is far below the OECD average of 72. The time has come for a rational readjustment of medical fees.

Improving the fee system is the most essential task. In Korea, the estimated cost recovery rate by type of medical institution does not even reach 70%. Medical fees fall short of covering costs, which means that for reimbursed services included in the national health insurance system, the more care providers deliver, the more losses they incur. As a result, medical institutions try to offset losses from covered services through non-covered services. This in turn leads them to set higher prices for non-covered medical services, increasing the public’s medical cost burden.

Regulations that suppress non-covered medical services need to be eased. In Korea, the so-called “three-minute consultation” is already widespread. In a low-fee medical environment, providers focus only on increasing patient volume to generate a certain level of profit. As a result, patients receive inadequate explanations in a very short period of time, the consultation ends, and they are left dissatisfied with the medical service. If non-covered medical services are further restricted, medical institutions will inevitably try to increase the number of consultations even more, leading to a decline in the quality of care.

The cost recovery rate for each type of medical service also needs adjustment. Compensation levels for basic care fees, such as consultation fees and hospitalization fees, are generally low, while imaging and diagnostic testing are compensated at relatively higher levels. As a result, medical institutions choose to increase the number of imaging and diagnostic test orders to overcome low fees. To prevent this, fees for basic care, surgery, and procedures should be raised, while those for imaging and diagnostic testing should be lowered, so that the cost recovery rate can be brought into better balance.

The phenomenon of avoiding certain specialties must also be addressed. Recently, because departments with few non-covered treatment items, including pediatrics and adolescent medicine, are being shunned, fewer medical professionals are entering those specialties. Unless the fee system is changed in a way that can resolve this phenomenon, there may be cases where pediatric surgery cannot be performed simply because there is no qualified personnel available to do it.

We must not forget that the healthcare environment should prioritize the relationship between providers and consumers. At present, the government determines and manages medical fees through the national health insurance system. But the time has come to create an institutional environment in which medical fees can be determined autonomously according to the principles of the market economy.

The readjustment of medical fees has become a task that can no longer be delayed if Korea’s healthcare system is to advance. To solve the problems arising from the low-fee medical environment, it is time to improve the fee system.

Jiyoon Jeong, Intern Researcher, Center for Free Enterprise (CFE)

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Original title: [칼럼] 의료수가, 재조정이 불가피하다

Author: Ji-yoon Jeong

Date: 2024-11-22

Source: https://www.cfe.org/bbs/bbsDetail.php?cid=free_opinion&idx=27032