Don’t rip off state-run health insurance

About 520,000 people saw a doctor 100 times or more in 2010, raising suspicions about being overly treated. Disclosing the figure on Thursday, the National Health Insurance Corp. (NHIC) regarded the patients as the main culprit for a growing deficit. Of course, some of them legitimately suffered from grave illnesses requiring extensive care. But most of them appeared to have had overtreatment or abused drugs.

The NHIC spent 1.5 trillion won ($1.3 billion) on paying medical bills for the most frequent beneficiaries, 63 percent of whom were 65 years or older, in that year alone. If it cuts the sum in half, the state-run health insurance system can drastically reduce its annual deficit of 1.3 trillion won. It is urgent for the NHIC to prevent patients from undergoing unnecessary treatments and tests. Cooperation by the doctors is indispensable.

It is surprising to hear that a patient went to the hospital 2,287 times in 2010. He saw a doctor six to seven times a day on average. It is hard to imagine what complications made it necessary for him to do so. Another patient received prescriptions for 20,984 days, raising a question about drug abuse.

The NHIC should look deeper into such abnormal cases to check if the patients overused health care services or doctors approved overtreatment or unnecessary tests. Investigations are necessary to verify allegations that some doctors and pharmacists might have collaborated with their patients to get insurance benefits illegally.

The government should also create an effective regulatory mechanism to monitor cases of illegal beneficiaries, both medical professionals and patients. The absence of such a monitoring system has caught the NHIC off guard in a fight against those ripping off insurance. It is also important to lay the legal groundwork for heavier penalties for illegal recipients.

Besides, the NHIC must consider reviving an annual cap on available insurance coverage days. The government eliminated the limit in 2006. The NHIC should have taken measures to prevent patients from abusing the deregulation. Disappointedly, it has done nothing, only worsening its financial conditions.

More importantly, the authorities should revamp the medical service system. The government initiated a medical reform in 2000 to prevent drug abuse by drawing a clear line between the role of doctors and that of pharmacists. But it has yet to produce intended results. Thus, the nation needs a broader reform to cut health care spending and regain the NHIC’s financial health.

The insurance shortfall is predicted to snowball to 10 trillion won in 2018 and 30 trillion won in 2025 amid the rapidly aging population. It’s time to take bolder action to avoid a potential collapse of the NHIC. The authorities, hospitals, doctors, pharmacists and patients should join efforts to eliminate overuse to keep the insurance system afloat.