The National Health Insurance Service (NHIS) saved approximately 350 million won in additional ultrasound examination costs after cracking down on excessive deferred diagnosis rates at breast cancer screening facilities, the agency said.
The NHIS announced Thursday that following on-site and written inspections of the top 100 facilities with the highest deferred diagnosis rates, the average rate dropped from 66.8% to 42.7%—a 24.1 percentage point improvement. The number of deferred diagnoses fell by 3,155 cases. One clinic saw its rate plummet 85.4 percentage points, from 94.3% to 8.9%.
Breast mammography results are classified into four categories: no abnormality, benign condition, suspected cancer, and deferred diagnosis. Deferred diagnosis requires re-examination or additional testing, triggering extra health insurance expenditures.
Last year, approximately 4.565 million people underwent breast cancer screening, with 500,000 (10.9%) receiving deferred diagnoses. Deferred diagnosis rates varied widely among facilities, ranging from 1.6% to 92.9%. Some 1,144 facilities (32.4%) had rates exceeding 13%.
The NHIS identified excessive deferred diagnoses for dense breast tissue, inconsistent interpretation standards, and inadequate quality control as primary causes.
"We confirmed that analyzing and managing facilities with high deferred diagnosis rates can improve examination accuracy and reduce health insurance expenditures," said NHIS President Jung Ki-suk. "We will strengthen evidence-based management to provide reliable screening services."