A Study on the improvement of the National Health Insurance and the Indemnity health insurance system : Focusing on protection of financial consumer and improvement of non-covered medical items

The scope of coverage of indemnity health insurance varies depending on the covered and non-covered items. The items covered by National Health Insurance mainly include doctor's consultation, hospitalization, surgery and examination, which are considered basic medical services. These items are determined according to the standards of health insurance and are included in the list of items determined by the National Health Insurance Corporation, so there are no major problems. On the other hand, non-covered medical items include elective treatment, non-covered drugs, specific tests and treatments are not covered by National Health Insurance. Non-covered medical treatment costs are not fixed at each hospital and are often expensive, so various illegal acts such as excessive treatment by hospitals and insurance fraud frequently occur, which increases the burden of medical expenses and insurance premiums on the people and seriously reduces the financial resources of private insurance companies. There seems to be a certain degree of social consensus on the need for urgent improvement in the various problems surrounding the indemnity health insurance. Meanwhile, the government has been specifying reform plans for non-covered medical items and indemnity health insurance centered around the Special Committee on Medical Reform. Representative reform measures include systematic management of the non-covered medical items market, introduction of non-benefit coverage to benefit coverage and managed coverage, prohibition of mixed treatment and rational improvement of indemnity health insurance product. All of these reforms ultimately lead to reforms in non-covered medical items and indemnity health insurance product. Among these, it is judged that systematically managing and controlling non-covered medical items and ultimately converting non- covered items to covered items as much as possible are the key factors that will determine the success or failure of this reform. Improving the non-covered medical items management system is not an easy task because it involves sharp conflicts of interest among the general public, the medical community, the National Health Insurance Corporation and private insurance companies. Therefore, it is necessary to devise a reasonable solution that can be agreed upon by the general public, the medical community and insurance companies. It is believed that the most important goal of non-covered medical items management is to promote the health of the people and reduce the burden of medical expenses. Therefore, improvements to non-covered medical items and the indemnity health insurance system should also be made from this perspective.