A patient was billed nearly 1.93 million won ($1,350) for stitching a cut measuring less than 1 centimeter on the philtrum, the area between the nose and upper lip, a case that has prompted calls to curb excessive uninsured treatment practices at medical institutions. The appropriate out-of-pocket cost was estimated at just 45,000 to 60,000 won, meaning the patient paid about 30 times more than warranted.
The Citizens' Coalition for Economic Justice and Rep. Park Jie-won of the Democratic Party of Korea disclosed the case at a press conference on uninsured treatment pricing and patient harm, held on the 15th at the coalition's auditorium in Seoul.
According to the coalition, a person identified as A visited a clinic in July with a younger sibling who had cut their philtrum on the corner of an electronic device. The clinic said the wound had torn through to the muscle and could leave a scar, and recommended expensive uninsured treatment.
"The tear goes down to the muscle, so it could leave a scar. We will use the best materials available to minimize scarring," the clinic told the patient, quoting 1,868,500 won in uninsured fees for closing a wound less than 1 centimeter long. Caught off guard by the sudden accident, A paid a total of 1,929,700 won out of pocket, including the uninsured charges.
But according to data the coalition obtained from National Health Insurance Service Ilsan Hospital through the National Assembly, the appropriate total charge for the case would have been 150,000 to 200,000 won, of which the patient's share was estimated at 45,000 to 60,000 won.
Ilsan Hospital also said it does not use the expensive uninsured hemostatic agents and similar materials that the clinic reportedly applied.
"The patient paid 1.93 million won — fully 30 times the 60,000 won the treatment should have cost — simply because of which doctor they happened to see," the coalition said.
Uninsured Care Falls Outside Government Oversight
The coalition attributed such harm to weak government oversight of uninsured treatment. Uninsured services are not covered by national health insurance, leaving patients to pay the full cost. Prices can vary from one institution to another, but patients have little ability at the point of care to determine what a fair price is or what alternative treatments exist.
The coalition said the government has not put in place adequate safeguards to limit the prices and use of uninsured services, allowing medical institutions to impose large bills on poorly informed patients without disclosing that insurance-covered alternatives are available.
It also called the Health Insurance Review and Assessment Service's price disclosure program for uninsured services ineffective, saying it covers only some items and does not make it easy for patients to compare prices across institutions.
As remedies, the coalition proposed banning the mixing of uninsured and insured services in a single course of treatment, requiring providers to report uninsured treatment records when filing insurance claims, and making it mandatory to explain insurance-covered alternatives and obtain patient consent before prescribing uninsured care.
In this case, the coalition said it plans to file a request with the Health Insurance Review and Assessment Service to verify the charges and is considering filing a criminal complaint over possible unjust enrichment and violations of the Medical Service Act.