The number of health insurance changes for the first time in 25 years... 2.7 trillion won to be invested in regional and essential medical care next year

(Seoul = Yonhap News) Reporter Seo Seong-ho = Of the 3.6 trillion won in health insurance finances that the government decided to invest to strengthen regional and essential medical infrastructure, 2.7 trillion won will be implemented first from January next year.

On the 28th, the Ministry of Health and Welfare held the 19th Health Insurance Policy Deliberation Committee (Geonjeongsim) of this year and decided on the implementation plan for reforming the health insurance fee structure.

The implementation plan approved on this day is a follow-up measure to the innovation plan confirmed at the 12th Public Health Review, and the implementation period of 2.7 trillion won out of the 3.6 trillion won annual investment plan to strengthen regional and essential medical care has been confirmed.

The remaining KRW 900 billion is scheduled to be implemented by the Public Health Commission within this year.

◇ Starting next year, regional preferential treatment will be invested at KRW 400 billion per year and final treatment at KRW 900 billion.

Health insurance premiums are the price for medical services paid by the government to medical institutions from health insurance funds. It is the product of the ‘relative value score’ determined for each individual action multiplied by the ‘conversion index’, which is the unit price per point.

Starting in January next year, the government will apply 'regional preferential rates' that provide more compensation to non-metropolitan areas and vulnerable areas within the metropolitan area (Gyeonggi Uijeongbu area, Namyangju area, Icheon area, Pocheon area/northwestern area and central area of ​​Incheon), starting in the areas of childbirth and neonatal intensive care.

Of the 400 billion won in regional preferential treatment, 300 billion won will be applied first next year, and the remainder will be implemented through additional deliberation.

Regional preferential rates (10% addition) will first be applied to delivery and hospitalization of critically ill newborns, and will also be applied to surgeries and treatments starting in March.

Compensation is especially provided at night and in emergency situations. Based on regional emergency centers, the number of emergency and severe surgeries at night and on holidays currently increases by up to 350%, but this will increase up to 470% from next year.

From January next year, consultation fees, which have been fixed for 20 years, and hospitalization fees, which have been fixed for over 10 years, will also increase.

In-depth examinations of 15 minutes or more at tertiary general hospitals and in-depth primary care consultations for children, which are currently under a pilot project, will be converted to this project.

In particular, in the case of in-depth examinations at tertiary general hospitals, the number of times per patient will be increased from the current 4 times a year to 6 times a year (8 times a year for children under 8 years old), and the operating standards for separate days and times will be revised to allow in-depth examinations at any time.

In addition, the chronic disease management fee applied to clinics with a chronic disease education and counseling system will be increased to 13 by adding 2 diseases, including rheumatism and chronic respiratory disease, to the group of chronic diseases, and a 20% addition will be applied compared to the current fee (30-50% addition for patients with 2 or more complex diseases).

Compensation will be strengthened by establishing the highest level of nursing placement in the intensive care unit for stroke and high-risk pregnant women, and hospitalization fees for isolation rooms and neonatal units will also be raised.

The Ministry of Health and Welfare is currently increasing compensation to 900 billion won per year for serious and emergency surgeries, procedures, anesthesia, etc., considering criticism that compensation for 'final treatment' leading to surgery in the emergency room is low.

For emergency patients hospitalized on holidays and at night, such as hemodialysis, the surcharge for first aid in emergency rooms will be increased by 50%, and the general anesthesia fee for general hospitals and higher medical institutions will be increased by 10 to 50% compared to the current rate. Meanwhile, the surcharge for severe surgeries and procedures and accompanying anesthesia at night and on public holidays will be strengthened from the current 100% to 150%.

◇ Strengthening the maternal and child medical system… ‘Function fee’ introduced for emergency patient transport

The Ministry of Health and Welfare will significantly increase the level of compensation for maternal and child medical centers starting from January next year.

First, a functional fee will be introduced for mother and child centers that accommodate patients who are urgently trying to be transferred or transferred from the central mother and child center.

In addition, according to the reform of the maternal and child medical supply system, differentiated fees by function are applied to severe, regional, and regional mother and child centers, and the fees are divided by the number of weeks of pregnancy.

For example, the Severe Mother and Child Center, which receives high-risk delivery patients under 34 weeks of age who have decided to transfer or transfer at the Central Mother and Child Center, receives an additional functional fee of 2.64 million won in addition to the current delivery compensation (approximately 4 million won).

Severely ill mother and child centers in non-metropolitan areas or six vulnerable areas in the metropolitan area receive an additional 3.3 million won in addition to the regional preferential rate of 660,000 won.

Amid social controversy over the search and seizure of the Pediatric Emergency Medical Center at Ajou University Hospital, an additional surcharge to compensate for hospitalization of critically ill newborns will also be established.

Accordingly, the Severe Mother and Child Center, which accepts patients with deliveries or newborns under 34 weeks for whom transfer or transfer has been decided by the Central Mother and Child Center, will receive an additional KRW 1.44 million in addition to the current neonatal intensive care hospitalization fee (KRW 957,000 per day). This reward can be applied up to 7 times.

In addition, differential additions depending on the number of weeks and 50% addition for treatment in the neonatal intensive care unit at the critically ill/regional mother and child center are also applied.

When applying the various additional fees that the government will promote, the compensation level (hospitalization fee) for high-risk deliveries under 24 weeks and neonatal intensive care treatment will increase from 31 million won to 62.01 million won based on 28 days.

The Ministry of Health and Welfare will also increase the fee for professional rehabilitation treatment by 10% for those with a high need for rehabilitation by professional personnel from January next year.

The number of institutions where children can receive customized and intensive rehabilitation will be expanded from the current 47 to a maximum of 68.

In addition, the establishment of an acute medical supply system and a rehabilitation medical system is planned to be promoted by submitting it to the National Health Council within the year.

◇ Conditional compensation to institutions entrusted with sample testing… Adjust the number and put it into consultation fees, etc.

The Ministry of Health and Welfare will provide conditional and differential compensation for two years starting next year to institutions that meet the requirements necessary to improve the quality of specimen testing among entrusted and entrusted medical institutions.

If conditions such as a result sharing system are met, a clinic-level entrusted medical institution receives a fee for analyzing and managing clinical results (KRW 1,400 per patient) up to four times a year per patient. If the entrusted institution performs high-level, low-frequency tests and tests requested from medically vulnerable areas, it receives fees for the relevant tests.

In addition, next year, by using the finances (linked finances) decided to link a portion of the conversion index increase rate to the adjustment of the relative value score, clinics and dental clinics will invest in consultation fees, and hospitals will invest in meals and injections.

Part of the money used to raise the conversion index is taken out through linked finance to further increase consultation fees, injection fees, and meal expenses.

Accordingly, the relative value scores of first consultation fees for clinics and dentists will rise to 5.2% and 2%, respectively.