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KMID : 0386819930030010018
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Journal of the Institute of Health Environmental Sciences
1993 Volume.3 No. 1 p.18 ~ p.32
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An Analysis on the Magnitude of Self-payment under the health Insurance Exclusion Clauses
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Abstract
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This study has aimed to estimate the magnitude of self-payment at the point of service under the national health insurance. Ten hospitals were purposively selected for this study. Three of them were tertiary hospitals in the metropolitan Seoul.
The
study has reviewed 428 discharge cases by way of the daily hospital census during October through November 1992. The size of the exclusion payment from health insurance benefits averaged at 39.6% of the total hospital inpatient expenditures. The
figure
was highest in the private hospital, 44%. The amount of exclusion clauses increased from 21.1% of the inpatient bill in to 1983 to 1983 39.6% in 1992. Meanwhile, the exclusion items were mainly composed of the difference between ordinary and
previlege
room and board charges and the standard fee schedule, which amounted to 40.2% of the total payment due to the exclusion clauses. The rest were expenses for anesthesia(14.2%), treatment and surgery(13.8%), and others. Such a rapid increase in
exclusion
items raises the following three policy questions:
1) Is it possible to include high cost technology such as MRI-CT in the insurance benefit package?
2) Can we extend the period of benefit coverage beyond 180 days?
3) What are the other efficient ways of controlling cost which stems from the exclusion clauses at the time of service?
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KEYWORD
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