On June 30, the FSS announced that it has signed a memorandum of understanding (MOU) with the NHIS to establish appropriate management of non-covered services and clarify the roles of public and private health insurance.
This agreement was initiated in response to concerns that the structure of non-covered services and the insurance that covers them has resulted in rising prices for certain non-covered items and excessive medical treatments.
Existing first to fourth-generation actual medical expense insurance plans cover 70% to 100% of non-covered treatment costs, leading to a concentration of usage in specific non-covered items. This overutilization has been criticized for increasing the loss ratio of actual medical expense insurance and driving up premiums, while also placing a financial burden on health insurance during the provision of covered services.
Payments from actual medical expense insurance for so-called 'top ten non-covered services,' such as manual therapy and extracorporeal shock wave therapy, account for nearly half of all non-covered insurance payouts.
In response, the government has been pushing for reforms in actual medical expense insurance led by financial authorities, while health authorities have been implementing policies to strengthen the management of non-covered services. This MOU is a follow-up measure aimed at enhancing policy effectiveness by linking the health insurance and actual medical expense insurance data held by both agencies.
The two agencies plan to monitor prices and usage of management-covered services and major non-covered items using actual medical expense insurance data. This will help analyze the effectiveness of non-covered service management policies and assess whether the medical community is making autonomous corrections.
Additionally, they will conduct joint research to redefine the roles of health insurance and actual medical expense insurance, and during the process of checking for financial losses in public and private health insurance, the FSS will provide relevant data on actual medical expense insurance.
The FSS stated, "We will continue to collaborate to establish appropriate management of non-covered services and clarify the rational roles of public and private health insurance, striving to create a medical environment where citizens can receive proper care with peace of mind."
* This article has been translated by AI.
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