Korean J Med.  2018 Apr;93(2):80-86. 10.3904/kjm.2018.93.2.80.

Determination of Health Insurance Fee Schedule and Strengthening Policy for Health Insurance Coverage

• Kim YS

• KMID: 2435174
• DOI: http://doi.org/10.3904/kjm.2018.93.2.80

Abstract

The resource-based relative value scale (RBRVS) was introduced in Korea as a payment system in 2001. However, the health insurance fee schedule had many problems. Unbalanced insurance fee schedules still occur, and the relative value was not divided between physicians' work and practice expenses. Furthermore, malpractice fees were not included in the total RBRVS. The first refinement project of the health insurance relative value scales was conducted in 2003 and the second project started in 2010. In the first project, final relative values were calculated under budget neutrality by medical departments, and imbalances within the departments were resolved. However, imbalances still existed between departments. In the second project, final relative values were classified and computed by the type of medical treatment. The final RBRVS has been applied step by step since 2017 and the imbalance problem of the insurance fee schedule has been partially resolved. The government recently announced strengthening the plan for health insurance coverage. The current coverage rate for total medical costs by national health insurance is 63%. The purpose of this plan was to increase the coverage rate by up to 70%. The government has suggested detailed plans but there remain many controversial issues and limitations with regard to the practical aspects. Thus, further research and suggestions are needed.

Keyword

Health insurance reimbursement; Insurance beneficiary; Resource based relative value scale (RBRVS)

MeSH Terms

Budgets
Fee Schedules*
Fees and Charges*
Insurance
Insurance Benefits
Insurance, Health*
Insurance, Health, Reimbursement
Korea
Malpractice
National Health Programs
Relative Value Scales