Health Insurance Faces Deficit: Crackdown on Over-Treatment & Special Judicial Police
South Korea’s National Health Insurance Service (NHIS) is strengthening its efforts to manage healthcare spending and address a projected budget deficit. These actions include bolstering the role of its ‘Appropriate Care Promotion Team’ and preparing for the potential implementation of a special judicial police force to oversee expenditures.
Addressing a Growing Financial Challenge
The NHIS is facing a financial turning point, with a projected deficit of 300 billion won (approximately $228 million USD) in 2026. This marks the first time the health insurance fund is expected to operate at a loss. According to the Second National Health Insurance Comprehensive Plan, the deficit is projected to grow to 800 billion won in 2027 and 1.6 trillion won in 2028.
Increased Scrutiny of Medical Practices
NHIS Administrator Jung Gi-seok stated that increasing medical service utilization, without a corresponding increase in population or significant changes in disease patterns, is driving up healthcare costs. The focus is now on evaluating the appropriateness of these services.
The NHIS is enhancing the capabilities of its Appropriate Care Promotion Team (NHIS-CAMP). This involves improving data analysis, providing information on medical billing, and conducting on-site investigations at healthcare facilities. The team will focus on identifying instances of potentially excessive care, such as unnecessary procedures like nasal endoscopy for common colds or excessive vitamin testing for patients with precocious puberty.
Potential for Increased Enforcement
The NHIS is also preparing for the possible launch of a special judicial police force, as directed by President Lee Jae-myung. This force would concentrate on investigating and addressing issues related to illegal medical practices, such as those associated with ‘dummy hospitals’ and pharmacies operating with borrowed licenses. The NHIS believes these institutions are particularly prone to over-treatment due to their primary focus on profit.
While concerns have been raised about potential overreach of authority, NHIS Administrator Jung Gi-seok clarified that the special police force’s investigative scope would be limited to illegal institutions, not individual doctors or pharmacists. It is anticipated that this force, with an estimated size of 40-50 personnel, could investigate up to 300 medical institutions annually.
Expanding Integrated Care Services
In addition to cost control measures, the NHIS is also expanding its role in integrated care. Starting next month, the NHIS will serve as the lead agency for the Integrated Care Support Project (NHIS-PICC). This initiative will connect medical, long-term care, and local government services, with 6 regional headquarters and 227 teams nationwide. The NHIS aims to leverage its data resources to proactively identify individuals in need of care and facilitate connections to appropriate services.
Frequently Asked Questions
What is the current financial status of the National Health Insurance Service?
The NHIS is facing a projected deficit of 300 billion won in 2026, with deficits expected to increase to 800 billion won in 2027 and 1.6 trillion won in 2028.
What is the role of the NHIS-CAMP team?
The NHIS-CAMP team is responsible for analyzing healthcare spending, identifying instances of potentially excessive care, and conducting on-site investigations at healthcare facilities.
What is the purpose of the proposed special judicial police force?
The special judicial police force is intended to investigate and address illegal medical practices, particularly those associated with ‘dummy hospitals’ and pharmacies operating with borrowed licenses.
As the NHIS navigates these challenges, how might these changes impact access to healthcare services for the South Korean population?