Non-reimbursement of ‘out-of-pocket medical expenses’ increased 1.8 times in 2 years… Low-income people who did not receive

It has been found that the number of cases of not receiving the benefits of the out-of-pocket cap system, which refunds a portion of medical expenses incurred by individuals to ease their financial burden, has nearly doubled in recent years.

In particular, these cases of non-refund were concentrated in low-income groups with poor access to information.

According to data received from the National Health Insurance Corporation by Park Yong-gap, a member of the National Assembly Health and Welfare Committee, a member of the Democratic Party of Korea on the 16th, the number of cases in which people did not apply for payment in excess of the out-of-pocket limit and did not receive a refund after the three-year statute of limitations passed increased by 84.8% from 15,759 in 2020 to 29,126 in 2022.

During this period, the unrefunded amount increased by 73.7% from 12.738 billion won to 22.12 billion won.

The out-of-pocket cap system is a system in which, in order to reduce the burden of household medical expenses, if the partial out-of-pocket expenses (medical expenses paid by the patient, excluding non-coverage, selective benefits, etc.) paid by a health insurance subscriber for one year exceed the individual out-of-pocket cap (890,000 to 10.74 million won as of last year), the National Health Insurance Corporation pays the excess amount and returns it to the subscriber and dependents.

When dividing those who did not receive refunds for medical expenses by income quintile, the proportion of low-income households (1st to 3rd quintiles) increased from 56.7% in 2020 to 64.2% in 2022 based on the number of cases.

On the other hand, the proportion of high-income groups (8th to 10th decile) decreased from 12.6% to 8.9% over the same period.

The main recipients of reimbursement under the out-of-pocket cap system are elderly people who have relatively low income and spend a lot of medical expenses.

In fact, of the 29,131 cases subject to refund expiration in 2022, 73.8% were over 60 years old, and 32.8% were over 75 years old.

For this reason, the Corporation is implementing a payment consent account system whereby if you check the 'payment consent account box' when submitting an application for payment in excess of the out-of-pocket maximum amount, payments are automatically made to that account even if there is no separate application later.

However, since the initial guidance is provided through a mobile platform and those who have not read the electronic document are notified by mail, the generation that is not familiar with online still remains in a blind spot.

Rep. Park Yong-gap emphasized, "The main beneficiaries of the out-of-pocket limit system are low-income and elderly people who may have difficulty reading or applying for electronic documents, and in the case of daily workers, their residence may not be fixed," and added, "As the administrative power of the Corporation is a significant waste, we need to think about ways to improve this type of application system."

Meanwhile, the number of long-term delinquent taxpayers (more than 10 million won, delinquent payments for more than 13 months) who received excess payments without paying health insurance premiums has increased rapidly.

From 397 people (KRW 284 million) in 2021 to 559 people (KRW 585 million) last year, the number of people increased by 1.4 times and the amount increased by 2.1 times.

From 2021 to June of this year, a total of 2,426 long-term delinquent taxpayers who received refunds for medical expenses amounted to 2.24 billion won.

Accordingly, the National Health Insurance Corporation plans to implement a delinquent deduction system that allows deducting delinquent insurance premiums and statutory collection fees from amounts exceeding the maximum limit.