The government has drawn up the 2026 National Health Insurance implementation plan to simultaneously expand National Health Insurance coverage and secure fiscal soundness. It envisions a structural overhaul that raises fees for essential care and trims overcompensated areas, while also activating expenditure efficiency measures such as curbing excessive outpatient use and tightening management of non-covered services.
The Ministry of Health and Welfare on the 25th reviewed the 2026 implementation plan for the Second Comprehensive National Health Insurance Plan (2024–2028) at the Health Insurance Policy Deliberation Committee. As the third-year execution plan of the comprehensive plan announced in Feb. 2024, it includes a review of the progress of 75 detailed tasks and the way forward. It is also the first annual plan drawn up since the launch of the Lee Jae-myung administration.
The comprehensive plan consists of four main directions: ▲ ensuring the supply of essential medical services and fair compensation ▲ reducing medical disparities and guaranteeing healthy lives ▲ enhancing the fiscal sustainability of National Health Insurance ▲ establishing a stable delivery system and a virtuous cycle structure.
◇ Lower overcompensation, raise essential care
The government will embark on structural improvements to the compensation system for essential care. In the first half, it will prepare a plan to adjust relative values based on expense analysis, and in the second half, it will cut overcompensated fees and use the secured resources to raise undercompensated essential care fees. The goal is to achieve "balanced fees" by 2030.
It will also strengthen compensation in areas where medical demand has declined, such as childbirth and pediatric care. The pilot project for maternal-child healthcare collaboration will be expanded, and conversion of the pilot project for establishing regional pediatric care cooperation systems into a full program will be reviewed in the fourth quarter. Post-payment incentives will also be strengthened for care collaboration networks in cardiovascular, cerebrovascular and emergency medical fields.
In tandem with payment system reforms, the government will also push to shift to performance-oriented review and evaluation. It will review whether to convert the leading project on analytic review into a full program and prepare a plan within the year to overhaul the healthcare quality assessment.
◇ Adjusting long-term care hospital fees… considering coverage for caregiving costs
Measures to narrow medical disparities and strengthen care linkages are also included in the implementation plan. National university hospitals transferred to the ministry will be supported to serve as hubs for essential care, and in the third quarter, new comprehensive secondary hospitals under the bundled secondary category will be designated to strengthen the functions of regional secondary hospitals.
For long-term care hospitals, the government plans to strengthen medical functions and reduce "social admissions" by improving fee schedules and patient classification systems. It will link long-term care hospitals with 229 local government systems to support discharged patients' return to the community.
Easing the burden of caregiving is also under review. The government is examining a coverage plan to lower long-term care hospital caregiving costs, which currently have a 100% copayment rate, to around 30%, and will gradually ease restrictions on participation by tertiary general hospitals in the integrated nursing-care service.
◇ Expanding the safety net to home-based rehabilitation, dementia and addiction treatment
Support will continue for the expedited listing of treatments for severe, rare and intractable diseases. By conducting authorization, evaluation and price negotiations in parallel, the system that shortens the listing period from the previous 330 days to 150 days will be maintained, and institutionalization will be considered after performance evaluation.
The plan also includes measures to reinforce the medical safety net, such as introducing home-based rehabilitation services for people with severe disabilities, expanding regions for the pilot program of dementia management primary care physicians, strengthening support for patients discharged from psychiatric institutions, and increasing treatment facilities for people with narcotics addiction.
The government will prepare a comprehensive plan to manage obesity among children and adolescents and continue the pilot program for children's dental primary care physicians. It will also raise fees for home hospice care and expand institutions implementing the life-sustaining treatment decision system.
◇ Introducing managed benefits and switching property-based premiums to a flat-rate percentage
Measures to strengthen fiscal soundness will proceed in parallel. In the second half, the government will push to revise the enforcement decree to tighten the criterion that currently applies a 90% copayment for more than 365 outpatient visits per year to more than 300 visits.
Monitoring and disclosure of non-covered services will be expanded, and in the third quarter, a "managed benefits" system will be introduced to reorganize the management framework for non-covered services. Linkages with indemnity health insurance will also be strengthened.
The premium contribution system will also be adjusted. Property-based premiums will be overhauled in the second half from a tiered points system to a flat-rate percentage, and a task force on contribution system reform will be operated to enhance equity.
The health insurance current-account surplus has already shrunk to 499.6 billion won in 2025. The government said it will push to expand the state subsidy budget and, in the first half, disclose a medium- to long-term fiscal outlook in five-year intervals to enhance transparency in fiscal management.
◇ Expanding flexible pricing agreements for new drugs and considering listing AI medical devices
For innovative new drugs, the government will push to improve cost-effectiveness evaluations and expand the flexible drug pricing agreement system. For essential medicines, it plans to ease supply instability by strengthening preferential pricing and swiftly restoring prices.
It will support the stabilization of the immediate market-entry medical technology system and consider ways to formally list artificial intelligence (AI) medical devices under National Health Insurance. It will also conduct monitoring of medical supply materials and pursue institutional improvements in parallel.
The government will promote a remote-access pilot project using National Health Insurance data for medical AI research and develop synthetic data, and it will expand four offline analysis centers. It also plans to increase the number of institutions linked to the "health information highway."