[Contribution] Non-coverage treatment of Oriental medicine should be covered by actual cost insurance to expand the public’s choice

Non-covered medical expenses for Oriental medicine were subject to actual cost medical insurance, but were excluded from the scope of compensation in October 2009 when the financial authorities and the insurance industry revised the 'Actual Cost Medical Insurance Standard Terms and Conditions' on the grounds that there were many differences in coverage between existing non-life insurance companies' products. Accordingly, we would like to increase the people's choice and accessibility to oriental medicine and further argue that insurance coverage for actual cost medical expenses is necessary in order for the people to receive quality oriental medicine without financial burden.

In the National Assembly audits conducted in 2012, 2013, and 2015, it was repeatedly pointed out that actual cost medical insurance should be applied to uncompensated treatment items at oriental medicine clinics and hospitals, and the Anti-Corruption and Civil Rights Commission also issued a press release in July 2014 titled ‘Uncovered medical expenses for oriental medicine with a clear purpose of treatment should also be covered by actual cost medical insurance’, requesting improvement on this issue to the Ministry of Health and Welfare and the Financial Services Commission. It has been recommended.

In Korea's medical care, 'oriental medicine' occupies a significant proportion along with western medicine. As of 2022, there are 15,124 oriental medicine medical institutions, accounting for 20.8% of all medical institutions, and 90 out of 231 public medical institutions nationwide have at least one oriental medicine department. In addition, according to a 2024 survey by the Ministry of Health and Welfare, 67.3% of people over the age of 19 have experience using oriental medicine, and 50% of outpatients and 43% of inpatients have experience using Western medicine clinics and hospitals for the same symptoms before receiving oriental medicine treatment.

Despite some disparaging claims that it is 'traditional therapy for health promotion', the purpose of more than 90% of people using oriental medicine is 'treatment of disease' rather than health promotion or beauty, and a high level of satisfaction is recorded with the treatment effect. Despite the status and importance of oriental medicine, according to the provisions related to actual cost medical insurance revised in 2009, oriental medicine non-reimbursed treatment is excluded from coverage under actual cost medical insurance.

As a result, medical consumers cannot receive actual cost medical insurance coverage even if they receive treatment that is not covered by oriental medicine, so even though they need to receive oriental medicine treatment, they are unable to properly receive oriental medicine treatment due to the burden of medical expenses, or even if they receive treatment, they have to pay the entire medical cost themselves. In addition, considering that Western treatment is covered more broadly than oriental medicine treatment, such as being subject to actual cost medical insurance and medical care benefits under the National Health Insurance Act when performed by a doctor even though the treatment is the same, there is a very big problem with the system that is designed to discriminate only against oriental medicine treatment without any justifiable reason.

Due to the above actual cost medical insurance standard terms and conditions, medical consumers are essentially blocked from the opportunity to sign up for actual cost medical insurance for non-reimbursed oriental medicine treatments, thereby limiting their right to self-determination to choose medical institutions and medical methods, freedom of contract, right to choose medical care, and the right to health or health.

When the state carries out legislative activities to restrict the fundamental rights of citizens, it must comply with the principle of prohibition of excess set forth in Article 37, Paragraph 2 of the Constitution, must not infringe on the essential content of fundamental rights, and even if fundamental rights are restricted, it must be limited to the extent of necessity.

In particular, the above actual cost medical insurance provision not only excessively infringes on the freedom of contract by blocking medical consumers from signing up for actual cost medical insurance products that cover non-reimbursed oriental medicine medical services, but also does not fully and comprehensively cover medical expenses at all just because it is oriental medicine treatment, thus broadly infringing on an individual's right to choose medical care, right to access medical care, and the right to health or the right to health, raising the question of whether the principle of prohibition of excess is observed.

Meanwhile, doctors and oriental medical doctors are both medical practitioners under Article 2, Paragraph 1 of the Medical Service Act, and are essentially the same group in that the rights and duties of doctors and oriental medical doctors as medical practitioners are equally defined throughout the Medical Service Act. However, the above actual cost medical insurance provision provides for insurance coverage in principle for Western medical treatment in general, including non-reimbursed treatment, especially manual therapy and extracorporeal shock wave therapy, which have a high potential for abuse and are currently problematic, while oriental medical treatment is excluded from all coverage regardless of whether it is for therapeutic purposes.

In other words, it violates the Constitution because it violates the basic rights of medical consumers, such as their right to self-determination, right to choose medical care, right to health, freedom of contract, and right to equality.

Expanding the public's choice by legitimately re-covering non-covered treatment that was excluded from the standard terms and conditions would be the only way to gain national consensus.

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[Contribution] Non-compensated treatment of oriental medicine should be covered by actual cost insurance to expand the public's choice (Shortcut)