Why 'Real-name 24' Automatic Claims Are Failing: Only 28% of Hospitals Participating

South Korea's ambitious initiative to streamline private health insurance claims through the 'Real-name 24' service is facing significant hurdles, with less than a third of eligible medical institutions participating. The Financial Services Commission (FSC) revealed that as of May 1st, only 28.4% of the total 104,925 medical facilities, including clinics and pharmacies, were connected to the system designed to simplify the claims process for individuals holding private health insurance.

The primary obstacle identified by the FSC is the reluctance of several major Electronic Medical Record (EMR) system providers to integrate with the 'Real-name 24' service. These EMR providers, which supply essential record-keeping software to a substantial portion of healthcare facilities (42.2% use non-participating EMR systems), are reportedly demanding exorbitant per-claim fees, effectively blocking widespread adoption. The FSC has stated its intention to continue persuading these companies to participate.

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The number of linked medical institutions for the 'Real-name 24' service, which allows for simple claims of private health insurance with a smartphone, is only 28.4%.

This low linkage rate means that a vast majority of policyholders cannot yet benefit from the convenience of having their medical institutions directly transmit claim documents to insurance companies. While the service allows for claims to be filed via the 'Real-name 24' app even after visiting a non-linked institution, the initial goal of seamless, on-site claims processing remains largely unrealized for most citizens.

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Most of the non-participating hospitals are using large EMR companies that are refusing to participate, demanding economic benefits.

To address this, the FSC is exploring several strategies to boost participation and improve user experience. These include strengthening integration with apps from insurance companies, banks, and credit card firms, enabling claims without needing a separate 'Real-name 24' app. They also plan to proactively prompt users to file claims when visiting participating clinics and pharmacies, and enhance accessibility by providing map services to easily locate connected facilities.

Furthermore, the commission aims to encourage facilities already using participating EMR systems but not yet linked to 'Real-name 24' to join by offering simplified application processes and technical assistance. The success of this initiative is crucial for improving consumer convenience in the insurance sector and reducing administrative burdens for both patients and healthcare providers. However, overcoming the resistance from key EMR providers remains the most critical challenge.

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We will continue to persuade them to participate.