보건복지부 영문홈페이지

Insurance to cover costs for maintaining complete dentures for the elderly beginning October 1^st, and pilot project for a refund system to be extended for 3 more years

- The 25^th round of meetings for the Health Insurance Policy Review Committee was held –

 

The Ministry of Health and Welfare held the 25^th round of meetings for the Health Insurance Policy Review Committee (the committee hereafter) on September 12^th to discuss revisions on a list of health insurance coverage/non-coverage items and a scoring system for beneficiaries, as well as ways to drive the Refund System.

 

<The elderly to receive insurance payments for maintaining complete dentures>

 

The committee had final deliberations and decided on ways to cover costs to maintain complete resin dentures under insurance coverage.

 

Beginning this October, senior citizens 75 years of age and older will be entitled to the new insurance benefits. This decision followed the ministry’s decision made this past July to have the cost of denture fabrication covered under insurance.

-       The people entitled to the benefits include first time complete denture wearers 75 years of age or older and current denture wearers who paid for their dentures themselves before July.

-       Seven categories (nine sub-categories) of maintenance activities to be covered. The costs of each activity are as follows:

 

<Costs of maintenance activities>

 

Classification	Maintenance activity		Unit for charge	Dentist (won)
Denture tissue surface reconstruction	Relining	Direct method	Per jaw	85,040
		Indirect method	Per jaw	165,200
	Rebasing		Per jaw	208,990
	Denture tissue surface lining		Per jaw	55,230
Dentures repair	Repairing artificial tooth		Per tooth	55,000
	Repairing denture gums		Per jaw	85,040
Dentures adjustment	Adjusting denture gums		Per jaw	56,210
	Occlusion adjustment	Simple	Per jaw	25,070
		Complicated	Per jaw	56,700

 

The senior citizens who go to the dentist will be reimbursed 50% of the costs shown above, and will therefore only need to pay between 12,500 won to 104,500 won.

-       However, beneficiaries will be limited to receiving the benefits 1-4 times per year for each category, and will have to make full payments for any extra treatment.

-       Detailed insurance coverage standards (number of approved rounds of coverage, etc.) will be prepared soon.

 

Senior citizens are expected to reduce financial burdens with the costs for necessary maintenance activities now covered.

-       Even if they move to another area after they get their dentures fabricated, they can still get their dentures maintained near their new residence at any time.

-       Low incomers among denture wearers who had their dentures before July 1^st when the insurance began covering denture costs may have difficulty getting their dentures re-fabricated due to additional costs. The new coverage is expected to benefit these people as well.

 

<Explanation of maintenance activities>

* Relining: adjusting a partial fit between the gums and the dentures

* Rebasing: adjusting a complete fit between the gums and the dentures

* Denture tissue surface lining (soft relining material): Softening the gap between the gums and the dentures

* Repairing artificial tooth: repairing an artificial tooth of the dentures when it is damaged or missing

* Repairing denture gums: repairing the gums of the dentures when it is damaged

* Adjusting denture gums: adjusting the part of the denture which touches the gums

* Occlusion adjustment: making adjustments so that the upper teeth and lower teeth occlude well

 

<Ways to promote the Refund System>

The Ministry of Health and Welfare discussed a pilot project of the Refund System which has been running for the last three years, and decided to extend it for another three years until September, 2015.

 

The Refund System is a way of negotiating drug prices so that the National Health Insurance Corporation (called the NHIC hereafter) receives a refund of the price difference between marked prices and actual retail prices of drugs.

-       Since its one-year pilot test in June, 2009, on drugs for rare illnesses which do not have alternative medications, the committee has extended the project twice, a year each time.

* The 10^th round committee meeting was in July, 2010, and the 13^th round committee meeting was in August, 2011

* Many countries including Australia, Taiwan, Germany and Italy are operating a similar system.

 

Results of the three-year project demonstrated that patients can be provided with drugs that the Refund System covers, while the pharmaceutical companies are also satisfied as they can retain their marked prices. The NHIC is also saving money on insurance payments as it receives the difference between the marked prices and the actual retail prices.

 

Moreover, the refund contract which has been renewed one year intervals under the project can now be extended for up to three years at a time.

The contract is to be renewed when it expires, and when it comes to price cut such as price-volume agreement, the marked prices is to be retained during the refund contract.,

 

The decision is expected to help provide patients with a stable supply of drugs necessary for rare illnesses.

 

*Attachment: an overview of the Refund System

 

<Attachment: an overview of the Refund System>

I.              An overview of the Refund System

(Definition) A system where the NHIC receives a portion of the refunds of the marked prices through negotiations between pharmaceutical companies and the NHIC

(Necessity) When pharmaceutical companies are supply monopolies and have absolute control over prices, such a system is necessary to prepare for any difficulty treating patients when drug price negotiations fail.

 

The system will meet the needs of organizations that determine drug prices, as it will help supply medication to treating patients, help the NHIC make financial savings by redeeming medication costs, and help pharmaceutical companies maintain global price policies.

 

<Example of the Refund System>

 

	Classification	Requested Prices	Usage	Costs	Results of refund negotiations
	Pharmaceuticals	100 won	10	1000 won	The price will be set at 100 won but the difference of 200 won (= 100-80) will be returned to the NHIC.
	NHIC	80 won		800 won

 

(Introduction Details) Pharmaceutical companies refuse to supply certain drugs, as local drug prices get lower than foreign markets due to improved ways to determine prices of new medicines as well as the nation’s control on drug prices.

-       They have refused to supply saying that it would have bad influences when negotiating prices with foreign countries once local prices are open.

* Drugs that pharmaceutical companies refused to supply: Fuzeon (Roche, ‘04~’09), Elaprase/Naglazyme/Myozyme (Sam-oh Pharm, ’09), NovoSeven (Novo Nordisk, ’09), etc.

 

For a continuous supply of drugs for rare illnesses with no alternative drugs, the Refund System was introduced in June, 2009.

* The committee decided to extend the pilot test two times, one year each time in July, 2010 (10^th round) and in August, 2011 (13^th round), and also decided to extend it an additional two more months in July, 2012 (21^st round).