Seven months have passed since the implementation of the simplified claim service for indemnity insurance, but the participation rate among hospitals is only 25%.
According to data received from the Insurance Development Institute by Lee Jung-moon, a member of the Democratic Party of Korea on the National Assembly's Political Affairs Committee, as of the 15th of this month, 4,602 out of 7,802 target medical institutions (hospitals and health centers) are participating in the simplified indemnity claim service. However, excluding the 3,564 health centers, only 1,038 out of 4,238 target hospitals are participating, resulting in a hospital participation rate of about 24.5%.
By hospital grade, all 47 advanced general hospitals are participating, while 243 out of 330 general hospitals are currently participating. The remaining hospitals (39.3%), long-term care hospitals (6.2%), psychiatric hospitals (6.9%), dental clinics (11.8%), and oriental medicine hospitals (10%) showed low participation.
Despite more than six months having passed since the service started, the low participation rate is attributed to difficulties in negotiations among the insurance industry, medical institutions, and electronic medical records (EMR) companies. The insurance sector agreed to bear the development and establishment expense of the Indemnity24 system, amounting to 100 billion won, along with an annual operational expense of 10 billion won; however, the medical community insists that additional administrative expense compensation is necessary for participation in this service.
The Korean Medical Association and the Korean Hospital Association released a statement last month, noting that "insurance companies should not reject the billing documents that the medical community is currently using voluntarily through fintech" and demanded compensation for the minimum administrative expenses needed for the maintenance and repair of the indemnity claim system. It is reported that the fintech-based indemnity insurance claiming method used by some hospitals requires insurance companies to incur a fee of about 1,000 won per claim.
For the electronic processing of indemnity claims to occur, EMR companies must be linked with the Indemnity24 system. However, EMR companies have no legal obligation to participate actively, which presents a significant issue. Furthermore, there are no penalties for not participating in the service. Therefore, proposals have been raised to impose fines to ensure compliance.
The simplified indemnity insurance claim system, which began in October of last year for hospital-level medical institutions, is set to expand to clinic-level medical institutions and pharmacies in October this year. If this continues, it has been pointed out that consumers may find it difficult to experience significant benefits.
An official from the Insurance Development Institute stated, "We are currently conducting individual consultations targeting hospitals and EMR companies," and noted, "As the participation of pharmacies has recently increased, the convenience for contractors is growing." According to the Insurance Development Institute, as of the 15th of this month, participation and linkage have been completed for 85 clinics and 1,053 pharmacies. As of the same day, the cumulative number of Indemnity24 subscribers reached 1,333,447, with a cumulative claim count of 282,809.