What is the problem with the current salary standard ③ | Improving policies with the voice of the patient

[헬스코리아뉴스 / 박민주] According to the Rules on the Standards for Medical Care Benefit of the National Health Insurance (Article 1-2), the Minister of Health and Welfare must provide medical feasibility, medical significance, clinical usefulness such as treatment effectiveness, cost effectiveness, patient cost burden, and social benefits. and health insurance financial situation, etc. to determine whether or not to be eligible for medical care benefits. When designated as a benefit item, the patient receives a significant portion of the medical expenses from the health insurance finance.

On the other hand, patients are more dissatisfied with expensive drugs because the patient pays the full cost for non-covered drugs. We looked at the current salary standards and what the problem was three times. [편집자 주]

[사진=헬스코리아뉴스 D/B]

Unreasonable salary standards such as discrimination from other diseases are not only a problem for osteoporosis. The jagged pay standards for special calculations have become a hot topic this year.

Severe psoriasis is a representative disease that patient groups have been demanding for improvement because the criteria for special calculations and the criteria for biologics are different. In the case of other immune diseases such as ankylosing spondylitis, the criteria for special calculation and treatment are the same, but only the severe psoriasis has a different standard, causing controversy over discrimination. In the same way that osteoporosis, which we looked at earlier, was applied with an unfair salary standard compared to chronic diseases such as diabetes and high blood pressure, severe psoriasis was also applied with an unfair special criterion for calculation compared to other immune diseases.

The special calculation is a system that reduces the out-of-pocket rate for patients with rare diseases and severe intractable diseases that are difficult to receive adequate treatment due to the economic burden of treatment by 10%.

However, at the 25th Health Insurance Policy Review Committee of the Ministry of Health and Welfare held last month, the special criteria for calculating severe psoriasis were newly revised. The Korean Psoriasis Association, a patient group for psoriasis patients, played a major role in this. After the Han Psoriasis Association took the lead and communicated with the government, the special criteria for calculating severe psoriasis were relaxed, allowing more patients to enjoy the benefits. There are still few cases in which the government’s health insurance policy has been revised in response to the needs of patient groups.

We met Kim Seong-gi, president of the Korea Psoriasis Association, and heard about the process and future plans until the standard for special calculations were relaxed.

Health Korea News met with Kim Seong-gi, president of the Korea Psoriasis Association on the 14th to hear the story behind the improvement of the special criteria for calculating severe psoriasis. [사진=박민주 기자]
Kim Seong-gi, president of the Korea Psoriasis Association, is expressing his position on improving the criteria for special cases for calculating severe psoriasis. [사진=박민주 기자]

Q. The special criteria for calculating severe psoriasis have been relaxed. What has changed from before?

A. In the past, for the new registration of special cases for calculating severe psoriasis, drug treatment and phototherapy were administered for 3 months each for a total of 6 months, and then the severity had to be confirmed. For re-registration, the method was to stop biological treatment and then conduct systemic treatment and then check the severity.

However, in this case, if two or more of the immunosuppressive drugs methotrexate, cyclosporine, acitretin, or phototherapy (PUVA, UVB) were selected and administered for 6 months, and the severity was confirmed, special calculations could be applied. Re-registration was possible only with the clinical opinion of a specialist without stopping treatment.

In particular, it is most encouraging that the contents of the mandatory phototherapy have been deleted. Phototherapy is usually performed two to three times a week, but it is not easy to receive treatment aside from work or study. There are not many hospitals that provide phototherapy, and there is a problem that patients have very poor access because treatment is mainly performed in large hospitals. Moreover, the actual treatment is completed in less than 3 minutes. As the mandatory phototherapy is deleted, more patients will be able to receive special benefits for calculation.

Q. The improvement of the special criteria for calculating severe psoriasis was made under the leadership of patient groups. What do you think?

A. I don’t think patients should just be guided by the policies of doctors or authorities. Patients, like medical staff, know deeply about their disease. As people who suffer from psoriasis ourselves, we know the disease better.

If patients come with valid evidence, wouldn’t it be acceptable to the medical staff or the authorities to some extent? Can we have a conversation about one point? I thought I think it was very meaningful in that it led the health care policy rationally through mutual communication.

Q. How did the negotiations with the government go?

A. We held three meetings with the Ministry of Health and Welfare and the National Health Insurance Corporation. It was difficult because it was not easy to collect data from patients, but Rep. Chung Chun-suk of the Health and Welfare Committee (along with the Democratic Party of Korea) was very helpful.

At the first meeting, the authorities presented data indicating that psoriasis accounts for a large proportion of the enactment of special calculation exceptions, and thus has a large impact on other diseases. However, when I looked at the data in detail, I couldn’t quite understand the results, so I analyzed the data again. When refuted by presenting the derived data, the authorities also admitted that there were errors in their data. In fact, it seems that the data-related incident has made them more active in negotiating with the authorities.

At the second meeting, the authorities announced that they would relax the provisions related to the re-registration of special calculation exceptions, but argued that it was difficult to change the standard because the new registration was a matter that had gone through a meeting of the expert committee.

However, the expert committee is an institution that also sets salary standards. Wasn’t it not a problem that severe psoriasis differs from other immune diseases in that the criteria for special calculations and benefits are different. The existing standard for special calculations requires that phototherapy and drug treatment be performed for 3 months each for a total of 6 months and the severity must be checked.

It was very frustrating because I couldn’t understand why the criteria set for the same disease were so different. There were many parts that I did not understand, such as why the two standards were set differently and on what data each standard was set. Because there were doubts about the two standards set in the first place, the trust in the expert committee was low, so I asked each question piece by piece. The authorities also agreed to some extent.

A mutual agreement was finally reached at the 3rd meeting held after that, and the contents of the agreement were finally decided at the resolution review meeting held in November. From January next year, the revised criteria for special calculation of severe psoriasis will be applied.

(Left) The Korea Psoriasis Association holds a press conference in front of the National Health Insurance Corporation in Wonju, Gangwon-do, on the afternoon of May 9, and urges improvement of the criteria for special cases of severe psoriasis. [사진=박민주 기자](Right) Kim Seong-gi, president of the Korea Psoriasis Association, is holding a one-person relay protest in front of the National Health Insurance Corporation (Health Insurance Corporation) in Wonju, Gangwon-do, on the afternoon of August 6, urging the withdrawal of the 'special system for discriminatory calculation'. [사진=한국건선협회 제공]
(Left) The Korea Psoriasis Association holds a press conference in front of the National Health Insurance Corporation in Wonju, Gangwon-do, on the afternoon of May 9, and urges improvement of the criteria for special cases of severe psoriasis. [사진=박민주 기자]
(Right) Kim Seong-gi, president of the Korea Psoriasis Association, is holding a one-person relay protest in front of the National Health Insurance Corporation (Health Insurance Corporation) in Wonju, Gangwon-do, on the afternoon of August 6, urging the withdrawal of the ‘special system for discriminatory calculation’. [사진=한국건선협회 제공]

Q. Twice this year, you held a one-person relay protest and press conference in front of the National Health Insurance Corporation headquarters in Wonju. Do you think it worked?

A. I think it was very big. After the first meeting, I thought that I had to take some effective action. The government judged that people showed some fear, reluctance, or an attempt to defend themselves against gathering and raising their voices.

So, I started a one-man relay protest. It was summer at the time, and a strike related to the regularization of non-regular call center workers of the NHIS was in progress. I was able to build bonds with the strikers and have many good memories.

About two weeks after the one-man relay protest began, the second meeting was held. In fact, if the results of the second meeting were not satisfactory, we planned to hold a relay demonstration in front of the Ministry of Health and Welfare in Sejong, but the demonstration ended in a much better mood than the first meeting.

In particular, President Moon Jae-in directly mentioned the relaxation of the special criteria for calculating severe psoriasis at the Mooncare 4th Anniversary Performance Reporting Contest, and I think that the relay protests had an effect on this as well.

Q. What kind of activities does the Korea Psoriasis Association plan to do in the future?

A. It is very important to manage psoriasis according to the individual effort of the patient. If early psoriasis patients see a doctor and start treatment soon after the onset, it may not become severe. Through the hurdle campaign, we want to encourage early treatment so that patients do not progress to severe disease.

I also suffered from psoriasis for 44 years, but thanks to treatment and management, I am still living without major side effects. I think it’s our job to help other psoriasis patients from getting worse.

Especially personally, I think patient groups should be at the heart of policy. Even if we don’t go to political power, I think that we can make our voices louder only if the patient group has some power.

I think that the existing domestic health care system was provider-centered. It was not patient-centric, but I think the healthcare system needs a shift in focus on the patient. I think the word ‘patient-centered’ must be put in front of public health care. We plan to make efforts to transform the health care system into a patient-centered one.

Copyright © Health Korea News Unauthorized reproduction and redistribution prohibited


Source: 헬스코리아뉴스 – 더뉴스 by www.hkn24.com.

*The article has been translated based on the content of 헬스코리아뉴스 – 더뉴스 by www.hkn24.com. If there is any problem regarding the content, copyright, please leave a report below the article. We will try to process as quickly as possible to protect the rights of the author. Thank you very much!

*We just want readers to access information more quickly and easily with other multilingual content, instead of information only available in a certain language.

*We always respect the copyright of the content of the author and always include the original link of the source article.If the author disagrees, just leave the report below the article, the article will be edited or deleted at the request of the author. Thanks very much! Best regards!