A man diagnosed with back and knee sprains following a traffic accident in March 2024 has undergone over two years of outpatient treatment at a traditional medicine clinic. He has visited the clinic 141 times and received 57 medical certificates, 34 of which were issued without any additional examination.
As the implementation of the so-called '8-week rule' to manage the appropriateness of long-term treatment for accident victims is delayed, cases of prolonged treatment that are difficult to filter out under the current system continue to rise. Critics point out that there is a lack of objective procedures to assess the necessity for additional treatment, leading to treatment durations extending from months to years and increasing the burden of auto insurance payouts.
According to the insurance industry on July 13, data from four major property and casualty insurers revealed that from January 2023 to the first half of last year, 8,242 accident victims received medical certificates more than 18 times. In 2023, the first year that required additional medical certificates for treatment extending beyond four weeks, 140 accident victims received certificates 18 times or more. This number has significantly increased as cases of repeated certificate issuance to extend treatment have continued.
The Board of Audit and Inspection also highlighted similar cases. A man diagnosed with a grade 12 spinal sprain following a January 2023 accident submitted 31 similar medical certificates to extend his treatment period, incurring medical expenses of 1,455,000 won.
The insurance industry cites the absence of an objective review process for assessing the necessity of additional treatment as a key reason for the recurrence of long-term treatment. Currently, when a medical institution diagnoses the need for further treatment, insurers find it challenging to verify its appropriateness separately. The existing method, which only checks for the submission of medical certificates, has limitations in managing long-term treatment.
The Ministry of Land, Infrastructure and Transport and financial authorities have been promoting the introduction of the '8-week rule,' which would allow a public body to assess the necessity for additional treatment for accident victims receiving care beyond eight weeks. The aim is to protect patients who genuinely need long-term treatment while filtering out cases where the necessity for treatment is unclear.
However, the traditional medicine sector has pushed back, arguing that imposing a uniform limit on treatment duration does not reflect patients' conditions and recovery speeds. As disagreements persist, the implementation of the new system remains stalled.
As long-term treatment continues, the financial burden of traditional medicine is also increasing. Last year, the average cost of traditional medicine per accident victim at four major property and casualty insurers was 1,083,000 won, nearly three times higher than the average cost of Western medicine, which was 355,000 won.
There has also been a rise in what is known as 'set billing,' where patients receive six or more of eight traditional treatments, including acupuncture, moxibustion, cupping, and herbal injections, in a single visit. Last year, the total outpatient treatment costs for traditional medicine at the four major insurers amounted to 817.4 billion won, with set billing accounting for 64.4% of that total.
The insurance industry views the expansion of set billing as one of the factors contributing to the increase in traditional medicine costs. However, the traditional medicine sector maintains that multiple treatments can be administered based on patient conditions and that it cannot be assumed that multiple procedures indicate over-treatment.
An insurance industry representative stated, 'The current four-week payment guarantee process only verifies the submission of medical certificates and does not objectively assess the appropriateness of additional treatment. The core of the 8-week rule is to ensure that medical judgments are made by a public body.' He added, 'As long-term treatment continues in some medical institutions, effective management measures are necessary.'
* This article has been translated by AI.
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