A survey has found that about 7 out of 10 seniors aged 65 and older find the increase in out-of-pocket costs resulting from higher medical fees burdensome. On September 30, the Korean Medical Association released the results of a public opinion survey on the Flat-Rate Outpatient System for the Elderly and urged the government and the National Assembly to reform the system.
The Flat-Rate Outpatient System for the Elderly is a program under which patients aged 65 and older pay only a fixed amount if their outpatient medical expenses at local clinics fall below a certain threshold. The KMA pointed out that since the fixed copayment threshold was set at 15,000 won in 2001, it has remained unchanged for 25 years, leading to an increase in cases where patients must pay more than 20% of their medical costs because they exceed the fixed-fee threshold. The KMA noted that because out-of-pocket costs vary significantly depending on the treatment cost bracket, this has led to considerable on-site confusion, including repeated explanations and complaints between patients and medical institutions.
The survey was commissioned by the KMA to Korea Research and conducted from September 11 to 18 among 1,100 adults nationwide aged 18 and older. A total of 53.5% of respondents said the increase in out-of-pocket costs for the elderly due to rising medical fees was “burdensome,” and among those aged 65 and older—who are directly affected by the system—the figure was 68.8%, 15.3 percentage points higher.
When asked if they would “likely reduce” visits to local clinics if out-of-pocket costs increased, 57.9% of all respondents and 61.3% of those aged 65 and older answered in the affirmative. Additionally, 59.0% of all respondents—and 66.7% of those aged 65 and older—believed that reduced visits to neighborhood clinics would negatively impact the health of the elderly. The Korean Medical Association explained that while these results do not directly measure an actual decrease in healthcare utilization, they signal that the public is well aware of the significant possibility that people might hesitate to seek necessary medical care due to financial burdens.
Fifty-eight point zero percent of all respondents—and 71.3% of those aged 65 and older—agreed that the increased out-of-pocket costs for weekend, holiday, and nighttime care should be alleviated. A total of 61.9% of all respondents and 64.9% of those aged 65 and older agreed that the flat-rate outpatient system for the elderly itself should be improved. Responses calling for improvements aimed at reducing sharp fluctuations in out-of-pocket costs totaled 48.5% of all respondents and 56.7% of those aged 65 and older.
Choi Un-chang, Chair of the Korean Medical Association’s Special Committee on the Flat-Rate Outpatient System for the Elderly and Medical Aid, stated at a press conference, “If the current structure remains in place, the burden felt by the public due to rising out-of-pocket costs and the confusion in the medical field could grow even further.” The KMA argued that, rather than uniformly lowering patient copayments, the medical fee brackets and copayment structure should be reasonably adjusted to mitigate the “cliff-like” transition between payment tiers while ensuring the sustainability of the National Health Insurance system.
The KMA conducted a signature campaign for one month starting August 13, targeting patients and their caregivers who visited clinics, and collected 49,196 signatures. It has also been holding consultations with city and provincial medical associations and local senior citizens’ associations. The KMA plans to comprehensively review cases from the medical field, public perception, and the health insurance budget, gather opinions from its affiliated organizations, and submit specific improvement proposals and supporting data to the government and the National Assembly.
