If number of treatments exceeds 365 times a year, patients should pay 90% of medical expenses

Mr. A had 1,425 outpatient visits in 2021. He visited a healthcare provider 358 days out of the year, excluding only 7 days. On one day alone, he received outpatient treatment at eight different healthcare providers.
In total, he received 3,779 medical procedures, mostly injections to treat back pain (58.9 percent) and basic physical therapy (24 percent).
Starting this July, outpatient visits after the annual number of outpatient visits exceeds 365 will be subject to a significantnincrease in out-of-pocket medical expenses.
From July 1, the Ministry of Health and Welfare will implement the Enforcement Decree of the revised National Health Insurance Act, which will significantly increase the co-payment rate for patients who excessively use unnecessary medical care.
According to the revised enforcement decree, those who receive more than 365 outpatient visits per year will have to pay 90 percent of the total cost of medical benefits for those excess visits.
Exceptions are made to children under the age of 18, pregnant women, the disabled, rare and incurable diseases, and severely ill patients.
Out-of-pocket expenses are the percentage of total medical expenses that you pay out of pocket, excluding those covered by your health insurance.
With health insurance, the outpatient deductible is about 20 percent. If you have private actual expense insurance, the actual deductible is lowered to zero to 4 percent.
The Ministry of Health and Welfare believes that some patients utilize more medical care than necessary. This overtreatment hurts health insurance finances.
According to the health insurance authority's statistics on outpatient utilization, there were 2,550 people who used outpatient medical care more than 365 times in 2021. The amount of money spent on salaries from the Health Insurance Corporation’s finances was 25.45 billion won.
There were also 529 people with more than 500 visits. Of these, 17 people used outpatient medical services more than 1,000 times.
As of 2021, the average South Korean visits the hospital 15.7 times per year. This is nearly three times the average of 5.9 visits by the member countries by the OECD member countries.

※This article has undergone review by a professional translator after being translated by an AI translation tool.