[Reporter’s Note] Playing the fair game of NHI coverage

In a sports game, a referee takes over the game from time to time.

 

When the set rules are not applied fairly, the players would naturally dispute over the biased refereeing.

 

Such is the case for South Korea’s Ministry of Health and Welfare (MOHW) regarding the National Health Insurance (NHI).

 

Recently, MOHW convened a general meeting for the Health Insurance Policy Deliberation Committee (HIPDC) and ultimately decided to narrow the coverage on the controversial substance, choline alfoscerate.

 

When the revised administrative notice is preannounced within this month, the coverage would only apply to dementia patients from September and patients with other diseases would have to pay for 80 percent of the expense.

 

Although another big issue of clinical reevaluation is yet to come, the controversy over the proven efficacy of choline alfoscerate raised since the National Assembly audit last year has been concluded for now.

 

Regardless of the pharmaceutical industry’s strong opposition, MOHW remains unmoved with the stance of ‘no evidence, no coverage.’ The point is not the reduced coverage on choline alfoscerate.

 

MOHW’s stance of not granting healthcare benefit on pharmaceuticals and medical practice without sufficient evidence, according to the NHI principle, is surely agreeable.

 

But the real point is what comes next—the government announced a pilot program for the Korean herbal medicine coverage.

 

From coming October, NHI reimbursement would be provided in Korean herbal medicine prescribed for specifically treating three diseases—menstrual pain, facial paralysis and cerebrovascular disease aftereffect.

 

Did the government forget about the reduced coverage on choline alfoscerate, all because of lack of sufficient evidence in efficacy?

 

Why should the billions of taxpayer’s money go to cover herbal medicine that has not even confirmed its efficacy, let alone safety?

 

Pharmaceutical companies strictly conduct clinical trials from Phase 1 through Phase 3 to prove the efficacy and safety of a drug in development.

 

The cost is astronomical.

 

But why is the government voluntarily offering evaluation on efficacy and safety of the herbal medicine during the pilot program?

 

Was the Moon Care shooting for unfairness?

 

Their stern stance on the principle seems contradictory, or even brazen.

 

If a referee calling two balls thrown into the same strike zone a strike and a ball, the players’ trust in the referee would plummet.

 

Untrustworthy referee’s existence itself becomes a contradiction.

 

MOHW should take a look back at its game of NHI coverage system and see if they are playing a fair game as a referee.