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Issue Report

Issue Report

Korea Healthcare Business Issue Report Private Medical Insurance 2022
December 2022113 PagesFormat: PDF

Synex Consulting Ltd.


Chapter 1 Understanding Supplementary Private Insurance
   1.1 Types of Supplementary Private Insurance
   1.2 Payment Methods for Supplementary Private Insurance
      1.2.1 Documentation for Supplementary Private Insurance Claims
   1.3 Structural Issues of Supplementary Private Insurance

Chapter 2 Market Status of Supplementary Private Insurance
   2.1 Coverage Volume of National Health Insurance
      2.1.1 Medical Expenses and Coverage Rate of National Health Insurance
   2.2 Market Size of Supplementary Private Insurance
      2.2.1 Number of Existing Contracts and Premium Revenue in Supplementary Private Insurance
      2.2.2 Current Status of New Contracts in Supplemetary Private Insurance

Chapter 3 Changes in Supplementary Private Insurance Coverage
   3.1 Changes in National Health Insurance Reimbursement Coverage
   3.2 Changes in Supplementary Private Insurance Non-Reimbursement Coverage
      3.2.1 Special Cases Designated as Severe Diseases
      3.2.2 ceiling system (out-of-pocket maximum)
      3.2.3 long-term care insurance for the elderly

Chapter 4 non-reimbursement over-treatment and claims
   4.1 manual therapy
   4.2 extracorporeal shock wave therapy
   4.3 prolotherapy
   4.4 magnetic resonance imaging diagnostics
   4.5 Cataract Surgery
   4.6 high intensity focused ultrasound therapy
   4.7 nasal valve reconstruction
   4.8 vacuum assisted breast masectomy
   4.9 varicose vein surgery
   4.10 Radiofrequency ablation of the thyroid gland
   4.11 MD Creams
   4.12 Scenario of tighter review criteria for major non-reimbursement items

Chapter 5 business strategy suggestions utilizing supplementary private insurance
   5.1 therapeutic materials pricing and eligibility for supplementary private insurance coverage
   5.2 pharmaceuticals pricing and eligibility for supplementary private insurance coverage
   5.3 Conclusion

Appendix - supplementary private insurance coverage
1 Standard Supplementary Private Insurance
   1.1 items covered
   1.2 definitions of terms
   1.3 coverage by individual item
      1.3.1 items covered
      1.3.2 items non-covered
2 special policy of supplementary private insurance
   2.1 items covered
   2.2 definitions of terms
   2.3 coverage by individual item
      2.3.1 items covered
      2.3.2 items non-covered

[Table 1] Supplementary Private Insurance Types and Structures
[Table 2] key features of each generation
[Table 3] changes in risk rate and amount of loss by year 2018-2021
[Table 4] Major Supplementary Private Insurance Companies (as of October 2022)
[Table 5] Changes in Population with Medical Insurance Coverage 2018-2022
[Table 6] Changes in Population with Medical Insurance Coverage by Age Group
[Table 7] Changes in Elderly Population (60+) with Health Insurasnce Coverage
[Table 8] Amount of Reimbursement and Non-Reimbursement Medical Care 2018-2022
[Table 9] Amount of Reimbursement by End-User Type
[Table 10] Number of New Contracts and Amount of Premiums
[Table 11] Changes in Profit and Loss of Supplementary Private Insurance 2018-2021
[Table 12] Amount of Claims Approved
[Table 13] Number of New Contracts
[Table 14] Number of New Contracts by Age Group
[Table 15] Number of New Contracts by Insurance Type
[Table 16] Amount of New Contracts by Gender and Insurance Type
[Table 17] Amount of New Contracts by Gender and Age Group
[Table 18] National Health Insurance Reimbursement Expansion 2021-2022
[Table 19] Comparison of Standard Supplementary Private Insurance Policy by Generation
[Table 20] Health Insurance Coverage Rates for the Four Major Serious Diseases
[Table 21] Special Cases of Serious Illness Benefits
[Table 22] Number of Special Cases of Serious Illness Enrolled
[Table 23] Number of Special Cases of Serious Illness by Age Group
[Table 24] Copayment by Income Level
[Table 25] Number of Long-Term Care Applications and Approvals 2017-2021
[Table 26] Changes in Long-Term Care Reimbursement 2017-2021
[Table 27] Manual Therapy Care
[Table 28] Comparison of Manual Therapy Care Billing
[Table 29] Extracorporeal Shock Wave Therapy
[Table 30] Comparison of Extracorporeal Shock Wave Therapy Billing
[Table 31] Prolotherapy
[Table 32] Comparison of Prolotherapy Billing
[Table 33] MRI
[Table 34] Comparison of MRI Billing
[Table 35] Cataract
[Table 36] Comparison of Eye Test Billing
[Table 37] Accommodative IOL Claims
[Table 38] Comparison of Accommodative IOL Billing
[Table 39] Uterine Myomar
[Table 40] High Intensity Focused Ultrasound Surgery
[Table 41] Comparison of High Intensity Focused Ultrasound Surgery Billing
[Table 42] Nasal Valve Reconstruction Care
[Table 43] Comparison of Nasal Valve Reconstruction Costs
[Table 44] Mastectomy Care
[Table 45] Comparison of Breast Biopsy Therapeutic Materials Costs
[Table 46] Varicose Vein Surgery
[Table 47] Radiofrequency Ablation of the Thyroid Gland
[Table 48] Comparison of Radiofrequency Rupture Treatment for Symptomatic Thyroid Benign Nodules Costs
[Table 49] Claims of MD Creams
[Table 50] Scenario of Tighter Review Criteria for Major Non-Reimbursement Items
[Table 51] Step-by-step Description of New Health Technology Assessment

[Fig 1] Supplementary Private Insurance Coverage
[Fig 2] Supplementary Private Insurance Payment Method - Reimbursement System
[Fig 3] National Health Insurance Payment Method - Third Party Payment System
[Fig 4] Medical Bill/Receipt Sample
[Fig 5] Medical Bill (Itemized Bill) Sample
[Fig 6] Supplementary Private Insurance Coverage
[Fig 7] Therapeutic Materials Approval and Eligibility for Supplementary Private Insurance Coverage
[Fig 8] Pharmaceuticals Approval and Eligibility for Supplementary Private Insurance Coverage

US$ 1,000 (excluded VAT)


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