The government is strengthening health insurance coverage for not only complex pediatric surgeries starting this year but also for treatments related to cervical and breast cancers.
The Ministry of Health and Welfare held the 4th Health Insurance Policy Review Committee on the 27th of 2025, and resolved to enhance compensation for complex pediatric surgeries, strengthen coverage for gynecological cancer treatments, and approve new drug listings.
First, the government plans to expand the number of additional items for complex surgeries for children under 6 from 284 to 319, totaling 603. Additionally, they will add an item that increases the compensation to 200% of the base rate for complex surgeries performed on children aged 1 to under 6. Current regulations allow for a compensation rate of 1000% for newborns under 1.5 kg and 400% or more for newborns under 1 year.
The target age will also be expanded to those under 16. The government will introduce 487 additional items and plans to provide a 100% increase in the compensation rate. A ministry official noted, "Surgical interventions during growth and development stages in children are areas that carry higher complexity and risk compared to adults, which warrants the need for additional compensation." They explained that they comprehensively considered resources from the Pediatric Surgery Society, custom equipment for pediatrics, specialist personnel, and factors like complexity, risk, and disease characteristics.
Compensation for gynecological cancer treatments, including cervical and breast cancers, will also be enhanced. The reimbursement for extensive hysterectomy performed at the early stage of cervical cancer will increase by 21%. Unlike hysterectomy and cervical surgeries that involve extensive removal of cancerous tissues including the uterus and cervix through laparoscopic or open surgery, this procedure aims to maintain fertility by only removing the cervix.
For breast cancer, health insurance benefits will be offered for digital tomosynthesis, which is more cost-effective than ultrasound or magnetic resonance imaging (MRI) during the diagnostic process.
Starting in March, the health insurance will also cover 'Vyndamax' (ingredient name tafamidis), a treatment for the rare disease transthyretin amyloidosis. This condition occurs when transthyretin, a plasma protein, is structurally broken down due to genetic mutations or aging. There are fewer than 100 patients in the country, with major symptoms including orthostatic hypotension, arrhythmias, fainting or blackouts, sensory disturbances, and diarrhea.
Vyndamax, developed by Pfizer, is the only approved treatment for transthyretin amyloidosis in South Korea. With this health insurance coverage, the out-of-pocket cost for domestic patients will decrease from 36.5 million won per year to 3.65 million won, which is a 10% reduction.
A ministry official said, "We are continuously pushing to enhance coverage by listing necessary new medications for treatments of serious rare diseases, leukemia, and anticancer drugs, while expanding the use of existing medications."