"Surgery is not allowed, but injections are."
A figure that starkly shows the distortion of Korea's medical fee schedule was disclosed on the 12th in a work briefing by public institutions under the Ministry of Health and Welfare. Kang Jung-gu, president of the Health Insurance Review & Assessment Service (HIRA), said that of 116 trillion won in National Health Insurance medical expenses in 2024, surgical fees across all surgical departments amounted to only 3.2 trillion won, while 2.9 trillion won was spent on nerve blocks. In other words, more of the insurance budget is being directed to relatively simple procedures than to complex surgeries.
Kang said, "There are cases of receiving 670 nerve blocks and more than 369 physical therapy sessions in a year," and noted, "Even just counting treatment for mild conditions, the total reaches about 18 trillion won annually."
Diagnostic testing shows a similar pattern. He said, "CT has criteria for when to scan, but there is no cap on how many times it can be done," adding, "In fact, there are cases of getting 130 CT scans in a year. Even if it is for the patient, there is an excessive aspect." In the case of MRI, there was significant controversy in the past over overuse, but the number of scans dropped after standards were refined, leading to the view that CT likewise needs clear management standards.
HIRA is confirming such distortions through claims data. Kang said, "Based on claims data, we broadly analyze fee trends and treatment patterns by specialty, and we also look at how often tests or procedures outside the normal range are repeated."
International comparisons also support the distortions in the domestic medical system. Kang said, "A direct comparison with the United States is difficult because the relative value structures differ, but compared with Japan, surgical fees show a gap of two to four times," explaining, "High-difficulty surgery involves many inpatients and must handle nighttime and weekend emergencies along with legal risks, yet compensation is woefully low." He added, "I have worked in surgery for 40 years, but in this environment, young doctors cannot help but avoid operating."
The limits of the current system are also clear. Kang said, "At present, it is difficult to check in real time what treatment a patient received at another hospital on the same day," adding, "There are cases where people go around several hospitals in a day for physical therapy." He stressed, "Curbing excessive testing and procedures and rationalizing medical use will also help stabilize finances."
HIRA is also reviewing an overhaul of the relative value system that underpins fee-for-service payments. Kang said, "When relative values were first designed, there were loopholes in the process of building treatment cost data," adding, "We are reviewing improvements to verify and standardize treatment cost data more objectively and to allow relative values to be adjusted on an ongoing basis."