A legal basis has been established for the "managed benefit" system to oversee non-reimbursable items with high concerns about overuse.
The Ministry of Health and Welfare said on the 18th that a partial amendment to the Enforcement Decree of the National Health Insurance Act establishing the legal basis for the managed benefit system was promulgated.
The revision is a measure under a state agenda to manage non-reimbursable items with potential for overtreatment within the health insurance system. By adding "cases where management is needed to ensure appropriate medical use for the purpose of enhancing social benefits," items among non-reimbursables requiring appropriate management were incorporated as managed benefits, a type of selective benefit.
Accordingly, prices will be set for items designated as managed benefits, and a 95% coinsurance rate will apply. Clinical criteria will be established to curb unnecessary medical use, enabling systematic management within the institutional framework.
Previously, in December last year, the ministry said it would designate manual therapy, percutaneous epidural neuroplasty, and radiative hyperthermia as items subject to managed benefits.
Ko Hyeong-u, director for essential medical support at the ministry, said, "With this amendment to the enforcement decree, an institutional framework has been established to appropriately manage certain non-reimbursable services with concerns about overuse," and added, "We will steadily carry out follow-up procedures, including setting fees and reimbursement standards for items selected as managed benefits such as manual therapy."