What is needed to claim health insurance payments after receiving medical treatment? Until recently, patients had to obtain receipts and detailed statements from hospitals and submit them directly to insurance companies. Missing a single document often meant returning to the hospital, and many would forgo claims altogether if the amount was only a few thousand won. Without a direct link between hospitals and insurance companies, patients had to bridge that gap themselves.
To alleviate this inconvenience, the electronic claims system 'Silson24' was introduced. Launched in October 2024 in hospitals and public health centers, it expanded to local clinics and pharmacies by October 2025, marking its second anniversary this month. When requested by consumers, necessary documents are electronically transmitted from medical institutions to insurance companies.
Previously, patients could send receipts via insurance company apps. However, Silson24 only sends specific documents—such as receipts, detailed medical expense statements, and prescriptions—related to the requested claim. Records of treatments not claimed are not transmitted, and the Insurance Development Institute, which facilitates document transfer, cannot verify the contents. The law prohibits collecting information for purposes other than claims. For this system to take root, trust must accompany convenience.
However, it is not yet available 'everywhere.' As of the end of September, only 47.7% of medical institutions were linked to Silson24. Among hospitals and public health centers, the connection rate is 60.0%, while for clinics and pharmacies, it stands at 46.7%. This means that in one out of two places where patients receive treatment, paper documents are still required. No matter how well-designed the system is, if it is not widely usable, consumers will not seek it out, and if fewer people use it, medical institutions will have less incentive to participate.
Signs of change are evident. Major suppliers of medical practice software have begun participating, increasing the connection rate from around 30% last spring to nearly 50%. This demonstrates that the integration of electronic systems is crucial for accelerating adoption. The user experience has also improved significantly. Since November of last year, claims can be made through Naver and Toss without needing a separate app, and participating hospitals can be found using Naver Maps or Kakao Maps.
Two challenges remain: connecting additional medical institutions that are not yet linked and expanding the user base. The elderly, who are often less familiar with digital devices but frequently utilize medical services, are a group that would benefit most from easier claims processes. It is essential to promote features like third-party claims, where children can assist with claims, and dedicated consultation services, while continuously refining the process to suit the needs of older users.
Consumer feedback is also vital. Silson24 includes a feature that allows users to request connections when their hospital is not linked. As more people use the system and requests accumulate, the incentive for medical institutions to participate increases. An increase in connections leads to more usage, and more usage can further drive connections, creating a positive cycle.
Discussions surrounding health insurance have primarily focused on premiums, loss ratios, and the management of non-covered services, emphasizing the sustainability of the system. However, for consumers, the ease of receiving insurance payments is equally important. Silson24 is not a system that changes coverage details; rather, it alters the pathway for consumers to access already promised benefits. The goal of Silson24 should be to enable easy claims for insurance payments, regardless of where treatment is received.
* This article has been translated by AI.
Copyright ⓒ Aju Press All rights reserved.