A patient identified as A, whose thyroid cancer had spread to the lymph nodes, paid 113,000 won ($81) for a thyroidectomy and lymph node dissection covered by national health insurance. Patient B, who received the same diagnosis, paid 8.5 million won ($6,100) for robotic surgery at a different university hospital. Another university hospital billed patient C separately for a robotic thyroidectomy and a lymph node dissection, pushing the bill to 38 million won ($27,300). For the same thyroid cancer treatment, the amounts paid by A and C differed by a factor of 336.
Uninsured robotic surgery continues to drain South Korea's indemnity health insurance system. Concerns have grown recently as billed amounts have climbed to as much as several hundred times the cost of conventional procedures.
Nine non-life insurers paid out 265 billion won ($190 million) in indemnity insurance claims for robotic surgery in the first half of this year, up 16% from 228.5 billion won in the second half of last year, according to financial industry data released on the 14th. Payouts for conditions other than cancer totaled 148.1 billion won, exceeding the 116.9 billion won paid for cancer-related procedures.
The problem is that robotic surgery in South Korea is classified as uninsured care, leaving no separate standards for eligibility or pricing. Japan and Taiwan cover robotic procedures that match conventional methods in safety and effectiveness, applying the same fee schedule as laparoscopic surgery. In South Korea, medical institutions set prices at their own discretion. Robotic surgery is also being performed for many conditions where medical technology reassessments have found insufficient evidence to judge safety and effectiveness.
Price gaps are substantial. For uterine fibroids, patients pay 300,000 to 500,000 won for laparoscopic surgery but 10 million to 16 million won for robotic surgery — up to 33 times more. For thyroid cancer, conventional surgery costs 1.4 million to 2.4 million won, compared with up to 43 million won for robotic procedures. An insurance industry official said patients often lack medical information and rely on their doctors' recommendations, meaning high uninsured costs can end up burdening both patients and indemnity policyholders.
Some medical institutions have been found to aggressively recommend robotic surgery to boost revenue, or to bill conventional procedures as robotic ones. One hospital in Seoul recruited patients with discounts of up to 49% after installing robotic surgery equipment. A hospital in Busan was found to have performed a uterine fibroid removal laparoscopically, using robotic equipment only for the final hemostasis, and later altered the surgical record.
The drain on indemnity insurance extends beyond robotic surgery. Payouts for uninsured injectable drugs rose 2.4% to 796.8 billion won in the first half of this year from 778.5 billion won in the second half of last year. Payouts for inpatient injections for both general and cancer patients declined, while outpatient injections such as nutritional supplements rose 6.9%. Critics say the faster growth in outpatient claims, compared with inpatient injections that serve a clearer therapeutic purpose, is widening the drain. An insurance industry official said that as long as medical institutions continue to set prices and treatment methods for high-cost uninsured care at their own discretion, the burden on indemnity insurance payouts will keep growing.
