Improvements to the National Health Insurance Fee Schedule Based on the Characteristics of Medical Expenses

Abstract

This study analyzed the characteristics of medical expenses in Korea using healthcare utilization data to suggest improvements to the national health insurance fee schedule. The main problems of the fee system are the reversal of the conversion index and the low compensation for examination fees. These can distort the allocation of resources and introduce dysfunction into the delivery system in healthcare services, which can also be identified through an analysis of medical expenses. While the share of outpatient treatment among hospital expenses increased, its share of clinic expenses decreased. The proportion of total medical expenses for clinics decreased, and that of outpatient medical expenses also showed a decreasing trend. The study suggests improvements to the national health insurance fee schedule based on scenario-based simulation results by unifying the conversion index and examination fees.