The Korean Medical Association (KMA) sharply criticized a government announcement to inject 3.6 trillion won annually in health insurance funds into regional and essential medical care, using savings generated by lowering fees for procedures such as computed tomography (CT) and magnetic resonance imaging (MRI), warning Tuesday that "major chaos in the medical community is expected."
"While deciding to inject funds to strengthen compensation for regional and essential medical care sounds plausible, it defines specimen testing and imaging tests as over-compensated areas and pushes through large-scale fee adjustments, with the damage passed entirely onto medical institutions, while the compensation measures bear no relation to reality whatsoever," KMA spokesperson Kim Sung-geun said at a regular briefing that day.
The Ministry of Health and Welfare unveiled its "Health Insurance Fee Structure Innovation Plan" that day, announcing that for specimen tests such as blood tests, it would lower the revenue-to-cost level from the existing 190% to 150%, and adjust CT and MRI fees from 200% to 150%, reducing spending by 1.7 trillion won and 700 billion won annually, respectively.
In announcing the "Health Insurance Fee Structure Innovation Plan" that day, the ministry said it would lower the revenue-to-cost level for specimen tests such as blood tests, which reaches 190%, to 150%, saving 1.7 trillion won annually, and adjust CT and MRI fees from the existing 200% to 150% to cut 700 billion won. The plan is to save 2.6 trillion won in health insurance funds annually by adjusting fees in testing areas that have had high compensation levels. Based on the funds secured this way, the government decided to additionally inject 3.6 trillion won annually into regional and essential medical care—the largest level since the health insurance fee system was introduced in 2001. However, the medical community is casting a critical eye, calling it a transfer of burden onto medical institutions under the pretext of supporting regional and essential care. In particular, testing fees, which had been maintained for decades through mutual settlement under market logic, were divided into consignment and entrustment fees, and even those entrustment-distribution ratios were decided without sufficiently reflecting the medical community's views, raising concerns that the resulting sharp fee declines will cause considerable damage to clinic-level providers.
At the briefing, complaints also erupted over the Health Insurance Policy Deliberation Committee's decision to set next year's increase rate for clinic-level medical care benefit costs (the conversion index) at 1.6%.
"The very fact that we have no choice but to accept the government's final proposal in an unpredictable, opaque negotiation process where the scale of funding is unknown is unfair," Kim said. "We feel devastated by the government's stance, which gives no consideration whatsoever to support for primary care and regional essential care." He argued that pushing through institutional reform that does not reflect the realities of the medical field would not only throw the medical community into major chaos but could also inflict damage directly on patients.
The KMA will hold a "Rally Against Managed Benefits" at 4 p.m. in front of Daehanmun in Seoul on the 28th, protesting the inclusion of manual therapy as a managed benefit starting next month. "At the rally, we will express our strong will to condemn the destruction of primary care caused by unilateral fee and non-covered service control policies," Kim said.
