Looking at foreign health insurance qualifications, baby medicine costs 2 billion won and 6 million won

The Ministry of Health and Welfare announced that it plans to expand investment in essential medical care and expensive drugs by improving the criteria for foreign health insurance dependents and preventing theft of health insurance qualifications. [사진=게티이미지]

The government has decided to prevent leaks in health insurance and supply super-expensive drugs that save lives at low prices, and to expand support for essential medical care such as brain surgery, heart surgery, and childbirth.

The Ministry of Health and Welfare announced in a report on the new government work plan (19th) that it would change the standard for foreign dependents covered by health insurance. The plan is to reevaluate and adjust some health insurance items such as ultrasound and MRI, which cause excessive use of medical care, and to prevent theft of health insurance qualifications by foreigners and increase investment in essential medical care and expensive drugs.

Last year, as a dependent of health insurance, a foreigner paid only 10% of medical expenses and received more than 3.3 billion won in health insurance benefits. There were many people who felt frustrated saying that some foreigners were eating away at the health insurance finances that our people had built up through blood and sweat.

Foreigners must meet essential requirements such as ‘living in Korea for at least 6 months’ in order to join the health insurance. However, dependents who are covered by health insurance thanks to those who are already enrolled can receive benefits regardless of the length of stay.

To take advantage of this loophole, the government plans to devise measures to prevent foreign dependents from entering Korea for medical treatment and leaving the country immediately after receiving health insurance benefits. It is also planning to prepare measures to prevent fraudulent receipt of health insurance benefits through lending or theft of health insurance cards, and receiving insurance coverage even without qualifications. In 2019 alone, the amount of treatment by non-qualified foreigners through Korea’s health insurance stood at 7.282 billion won.

In this way, even by saving money on health insurance that leaks to foreigners, it is possible to supply super-expensive medicines that can save life-threatening babies at a low price. There was also a case of a 24-month-old patient with spinal muscular atrophy (SMA), who received an ultra-expensive rare disease treatment ‘Zolgensma’, which costs 1.98 billion won at a time, at 5.98 million won according to the health insurance application.

Spinal muscular atrophy is a rare genetic disease in which muscles gradually atrophy due to gene mutations. As the disease progresses, the muscles weaken, making it difficult to breathe. If untreated, severe type 1 patients usually die before the age of 2 years or remain permanently on a ventilator. Zolgensma from Novartis, a pharmaceutical company, can treat spinal muscular atrophy with a single dose.

In Korea, this drug was approved by the Ministry of Food and Drug Safety in May last year, but no one used it due to its high price. It is the most expensive drug in Korea, and the cost of a single dose is close to 2 billion won when not covered, but you only have to pay up to 5.98 million won depending on the application of health insurance.

The government also introduced essential medical measures to save lives, such as internal medicine, surgery, obstetrics and gynecology, and pediatrics. The government plans to introduce public policy fees for areas that young doctors avoid, such as brain surgery, heart surgery, and childbirth. In the field of essential medical care directly related to life, whether private or public, the concept of ‘public’ will be introduced to prepare policy alternatives such as an increase in the number of medical services. It is a plan to induce young doctors to support in the long term by helping fields that are difficult and have a high risk of litigation and make less money than other fields.

Reporter Kim Yong-eok ecok@kormedi.com

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