The Problem of Forced Insurance Coverage on Prenatal Ultrasound

Lee, Keun Young

Abstract

On January 2007, the government announced its policy "Total Care of Pregnancy and Delivery; National Responsibility on Pregnancy and Delivery." While the policy is welcome, there are currently two problems with the plan. First, there is no provision for high-risk pregnancy. Second, the government's plan to cover the expenses on prenatal ultrasound is limited to payments for obstetrics only. The reasons why the government should not be so hasty in forcing its plan to cover current co-payment on prenatal ultrasound are the followings: first, physicians' techniques in making proper ultrasound images and doctors' abilities of ultrasound image interpretation cannot be standardized. Second, the types of ultrasound are diverse: conventional ultrasound, level II ultrasound, 3D ultrasound, doppler ultrasound, portable ultrasound, etc. Third, ultrasound fees are also charged by radiology, internal medicine, and other clinical fields. It raises a question of fairness if the government covers ultrasound expenses for obstetrics and gynecology alone. Lastly, the current medical fees are computed only by the Health Insurance Review Agency (HIRA) without consultation with medical suppliers. Furthermore, there is no systematic principle for estimating medical fees. The Korean Society of Obstetrics and Gynecology proposes alternative plans: "Total Care of Pregnancy and Delivery" should include support for high-risk pregnancy, support for prenatal care fees except those for sonography, and payments of cash bounties to mothers upon delivery of their babies. After sufficient government budget is secured, harmonious arrangements between the government and the clinical fields that use ultrasound should be made for the systematic computation of ultrasound fees.