Insurance companies take on traditional medicine as bills mount

A woman in her 50s suffered a minor contusion in a car accident in November 2014 and visited a herbal medical clinic. She ended up visiting the clinic 473 times over eight years and paid a total of 27 million won ($20,537) for treatments, including..

Members of the Association of Korean Medicine shave their heads in a protest in front of the building of Ministry of Land, Infrastructure and Transport in Sejong on March 29. The ministry is planning to revise the policy for herbal medical clinics to reduce the prescription period from 10 days to five for patients from car accidents, and file details about their medial bills to their insurance companies. [NEWS1]

A woman in her 50s suffered a minor contusion in a car accident in November 2014 and visited a herbal medical clinic. She ended up visiting the clinic 473 times over eight years and paid a total of 27 million won ($20,537) for treatments, including acupuncture, herb medicines and cupping therapies — all of which her insurance company must pay to the clinic.

Insurance companies are battling the herbal medicine business over the excessive treatment of patients, especially related to car accidents.

They argue that traditional medicine hospitals and clinics overtreat patients with minor injuries, which in turn drives up premiums. The herbal medical community argues that the rights of doctors and patients to treat or receive treatment should be protected.

Members of the Association of Korean Medicine staged a protest, shaving their heads in front of the Ministry of Land, Infrastructure and Transport building in Sejong on March 29. The chairman of the association, Hong Joo-eui, after shaving his head on March 26, is on a hunger strike.

The association is striking against the ministry’s plan to reduce the prescription period from 10 days to five, and make it mandatory for patients to provide detailed information on their medical bills to insurance companies. The association says the new measure “restricts” the rights of patients from car accidents to receive treatment.

Herbal medicine fees were 58.2 percent of car insurance payments in 2022, according to data from the Health Insurance Review & Assessment Service (HIRA) on Sunday. That's up 35.2 percentage points from 2015’s 23 percent.

Based on data from 2021, herbal medicine hospitals and clinics are 15.2 percent of all medical facilities, and the number of patients who suffered minor setbacks from car accidents has been decreasing since 2020 due to Covid-19 pandemic. Insurance companies claim that treatment fees from herbal medical clinics continue to rise because doctors unnecessarily treat their patients with acupunctures and herb medicine.

The herbal medical community retorts that the patients tend to seek out their hospitals instead of other facilities. When comparing data from 2017 and 2021, the number of injured who visited medical facilities shrunk 18 percent to 1.5 million, while those who visited herbal medical facilities jumped 74 percent to 1.5 million.

“When the patients go to a hospital, they leave dissatisfied because they just get an X-ray and receive physical therapy, so they seek herbal medicine clinics,” said a source in the community.

The Ministry of Land, Infrastructure and Transport is pushing ahead to limit prescriptions from herbal medical doctors as average medical expense per patient is substantially more for the herbal medicine compared to other medical facilities.

Average medical fees per person for herbal medicine facilities was 1.08 million won last year, triple that from other hospitals, which was 335,000 won, based on data from four insurance companies — Samsung Fire & Marine Insurance, Hyundai Marine & Fire Insurance, KB Insurance and DB Insurance.

“The purpose and standards of prescriptions for general hospitals is set in stone. For herbal medical clinics, it has become the norm for the doctors to give a 'package' prescription consisting of acupuncture, cupping therapy and herb medicine,” said a spokesperson from General Insurance Association of Korea.

Insurance companies blame herbal acupuncture and herb medicines for the huge costs.

Herbal acupuncture is a combo treatment of herb medicine and acupuncture, in a modern adjunctive technique that utilizes the injection of natural herbs or biologic substances into acupuncture points. Medical expenses for herbal acupuncture from car insurance was 144.3 billion won in 2021, a seven-fold increase from 2015, according to HIRA. The number of medical treatments a patient receives varies depending on which facility they go to, which is what insurance companies criticize as excessive treatment.

“Within a week of the accident, a patient may visit the hospital to receive herbal acupuncture every day, but there is an unwritten rule in which HIRA cuts back on fees charged to insurance companies from the second week,” said an insider from the herbal medicine community. “We share this standard among doctors, and we try to follow this rule.”

About 76 percent of patients who visit the hospitals get a 10-day prescription, according to HIRA, regardless of the degree of the injuries or symptoms.

Fees for herbal medicine charged to car insurance policies nearly tripled to 280.5 billion won last year compared to 2015’s 97.4 billion won.

While insurance companies argue for a need to cut back on the number of days of treatment from 10 to 5, the herbal medicine community argues that it needs a medical reason to change its policy.

“To unconditionally reduce the number of herbal acupuncture treatments or the prescription is merely an attempt by insurance companies to reduce their losses,” said a spokesperson from The Association of Korean Medicine. “What we should do is to set the bar higher to improve the quality of prescriptions by specifying the exact proportion and component of prescribed medicine, and for doctors to make an effort to prevent excessive treatment within ourselves.”

BY KIM KYUNG-HEE [lee.jaelim@joongang.co.kr]