"Surgery is out, injections are in."
A figure that starkly shows the distortion of Korea's medical fee schedule was disclosed on the 12th in a briefing by public agencies under the Ministry of Health and Welfare. Health Insurance Review & Assessment Service (HIRA) President Kang Jung-gu said that of 116 trillion won in National Health Insurance medical spending in 2024, surgery fees across all surgical departments amounted to only 3.2 trillion won, while 2.9 trillion won was spent on nerve blocks. It means more health insurance funds are being funneled into relatively simple procedures than into high-difficulty surgeries.
Kang said, "Essential high-difficulty surgical fields such as neurosurgical brain surgery, thoracic cardiac surgery, brain and abdominal surgery, and ear, nose and throat head and neck surgery are relatively undervalued," adding, "As this structure persists, the aversion to essential departments is deepening."
HIRA is confirming this distortion through claims data analysis. Kang said, "Based on claims data, we are broadly analyzing fee trends and treatment patterns by sector," and noted, "We are also looking at how often tests or procedures outside the normal range are repeated."
CT scans were cited as a representative example. He said, "CT has imaging criteria, but there is no cap on 'how many times you can scan,'" adding, "There are actually cases of getting 130 CT scans in a year. Even if it is for the patient, there is an excessive aspect." As with MRIs—whose scan volumes fell after standards were refined amid past controversy over over-imaging—there is a recognition that CT also needs management standards.
HIRA also plans to overhaul the relative value system that underpins fee-for-service. Kang said, "When the relative values were first designed, there were loopholes in the process of building the medical cost dataset," adding, "We are reviewing improvements to verify and standardize the medical cost data more objectively and to allow relative values to be adjusted on an ongoing basis."
International comparisons also back up the distortion. Kang said, "It is hard to make a simple comparison with the United States because the relative value structures differ, but compared with Japan, surgery fees show a gap of two to four times," adding, "High-difficulty surgery involves many inpatients and requires handling night and weekend emergencies as well as legal risks, yet compensation is woefully low." He added, "I have been a surgeon for 40 years, but in this environment, it is reality that young doctors are shunning surgery."
He also flagged the seriousness of overuse. Kang said, "There are cases of receiving nerve blocks 670 times a year or more than 369 sessions of physical therapy," adding, "Even just for mild conditions, treatment costs reach about 18 trillion won a year." HIRA is running a program to prevent excessive medical use, and related legislation has passed the National Assembly.
However, he also said the limits of the current system are clear. Kang explained, "At present, it is difficult to know in real time what treatment a patient received at another hospital on the same day," adding, "There are cases where patients go to multiple hospitals in one day to receive physical therapy." He said, "Reducing excessive tests and procedures and rationalizing medical use will also help stabilize the finances."