민간건강보험에서 정신과 질환에 대한 보험비 지급 관련 약관 현황과 문제

Abstract

Objectives: Recently, Korean psychiatrists have noticed the complaints from probands and family members that private health insurance companies do not pay for most psychiatric disorders. Furthermore, other than not being able to be insured, probands cannot even apply for the insurance because of their medical record of psychiatric disorders. Authors investigated and reviewed contracts of Korean private insurance companies to find reasons for banning psychiatric disorders from insurance policies. Methods: Authors reviewed more than 650 contracts from 51 insurance companies. Results: Among all the psychiatric diagnoses, few of them—dementia and some other organic mental disorders—are guaranteed to be paid from insurance companies. Less then 10 contracts say they pay for psychiatric illnesses. Most insurance companies have contracts prohibiting F codes; however, there are not enough reasons in contracts. Conclusions: In the private health insurance system, psychiatric illnesses have almost no rooms. It is very urgent to add space for patients with psychiatric illnesses and psychiatrists in the insurance policies.