Flu IV Drip Insurance Claims Surge 3.3-Fold Amid Overtreatment Concerns

Insurance payouts for non-covered injectable treatments have more than tripled this year as the flu epidemic spreads across South Korea, with some clinics recommending expensive IV drip treatments that cost up to nine times more than oral medications. Industry observers warn that excessive medical treatment is draining private health insurance funds.

According to financial industry data released Wednesday, major non-life insurers including Hyundai Marine & Fire Insurance (001450.KS) and Meritz Fire & Marine Insurance paid out 301.5 billion won in claims for non-covered injectable treatments from January through November, up 40.8% from the same period last year. Of this amount, 71.6 billion won was paid for flu-related non-covered injections, a 235.7% surge compared to 21.3 billion won in the same period last year.

The sharp increase in flu-related non-covered injection claims is primarily due to the surge in flu patients. According to the Korea Disease Control and Prevention Agency, 66.3 out of every 1,000 outpatients visiting 300 medical institutions nationwide showed flu symptoms during the week of December 9-15, a 14-fold increase from 4.6 patients during the same period last year. The agency issued a flu alert in October as the seasonal outbreak began approximately two months earlier than usual.

The concern is that non-covered injection prescriptions have surged particularly at primary and secondary care facilities such as neighborhood clinics. From January through November, the increase in flu-related non-covered injection claims was 238.7% at primary care facilities and 225.1% at secondary care facilities, far exceeding the 68.5% increase at tertiary hospitals. Some neighborhood clinics are frequently prescribing flu injections and nutritional supplements, marketed as more convenient and faster-acting than oral medications, and issuing medical opinion letters for insurance claims.

As a result, flu treatment costs vary widely even among primary care clinics depending on physician prescriptions. A flu patient at Clinic B in Seoul's Seongdong District filed an insurance claim for 43,800 won including consultation and medication fees, while another patient treated at Clinic L in Suwon, Gyeonggi Province filed a claim for 377,900 won including expensive non-covered injections—a ninefold difference for the same illness.

Private health insurance payouts are rising rapidly as overtreatment becomes more prevalent. According to the Financial Supervisory Service, total private health insurance payouts reached 15.2234 trillion won last year, up 8.1% from the previous year. Claims for non-covered injections including nutritional supplements rose 15.8% to 2.8092 trillion won, accounting for nearly 20% of total payouts. With payouts growing faster than premium income, the loss ratio for private health insurance climbed from 116.2% last year to 119% in the first half of this year. Insurers are losing more than 1 trillion won annually on private health insurance alone.

As overtreatment aimed at insurance payouts continues, an abnormal structure has become entrenched: the top 9% of policyholders collect 80% of total payouts, while 65% of policyholders pay premiums without receiving any benefits. The government is currently working to launch fifth-generation private health insurance that would raise the co-payment rate for non-critical, non-covered treatments from the current 30% to 50% and exclude manual therapy and non-covered injections from coverage. FSS Governor Lee Chan-jin has also stated that authorities will "raise the co-payment rate for non-critical non-covered treatments."

However, a year-end launch appears unlikely due to delays in regulatory revisions and disagreements with the medical community. "Even elementary school parents are competitively getting IV drips for their children," an insurance industry official said. "We need to quickly raise the co-payment rate for non-critical non-covered treatments to break the vicious cycle of overtreatment and insurance claims."