“비급여 풍선효과, 정부선 알 수 없어…민간 데이터로 ‘지속가능한 의료’ 기여”

A specialist surgeon, who worked at the Ministry of Health and Welfare for eight years, chose to join Samsung Life’s Longevity & Value Research Institute as its new director. In an interview with Haniherle, Director Jeong Woo explained that he wanted to analyze private insurance data, which he couldn’t access while working at the Ministry.

He believed that sharing the results of this analysis could contribute to sustainable healthcare in Korea. He had been interested in health insurance policies since his medical school days, but felt that he needed to understand the healthcare system first. After completing his residency in internal medicine and becoming an infectious disease specialist, he earned a master’s degree in public health from a university in the United States.

He then worked as a consultant for a year and a half before joining the Ministry in 2018. During his tenure, he dealt with topics such as health insurance and medical institution systems, including the implementation of electronic entry codes during the COVID-19 pandemic. He pointed out that understanding how medical payments are used in the field was difficult within the Ministry, as the data on un-covered medical services was not available in the health insurance agency’s database.

The high quality, wide accessibility, and low cost of healthcare in Korea can be attributed to what has been called "The Iron Triangle" of healthcare policy, which attempts to balance all three elements simultaneously. However, rapid aging has made this challenging, and the director argues that society must now decide which medical services are truly valuable.

Private insurance data can help identify underutilized medical services, such as massage therapy, which can lead to overuse if not properly managed. The director shared an example of massage therapy, which became a subject of concern when it started generating revenue through billing. After joining Samsung Life, he was able to directly observe an increase in billing for similar services, like minimally invasive surgery.

He believes that high-cost treatments like robotic surgery and cancer drugs should be more aggressively covered by health insurance, as patients and families cannot afford these treatments without them.