The National Health Insurance Service decided to raise the fee schedule—the prices it pays medical institutions for services—by an average of 1.65% next year. However, talks with clinic-level institutions broke down after the sides failed to narrow differences over the rate.
On the 30th, the National Health Insurance Service said it concluded negotiations on the 2026 reimbursement (fee schedule) contracts with seven provider groups, including the Korean Medical Association Organization, and finalized an average increase of 1.65% after deliberation and a vote by the Finance Operation Committee.
Last year, for the first time since 2018, all seven types reached fee deals, but this year the clinic category ultimately failed to reach an agreement. This is the first breakdown in clinic-level fee negotiations in two years, since 2024.
The increases by category were set at 1.2% for hospitals, 1.3% for long-term care hospitals and psychiatric hospitals, 2.6% for dental, 3.0% for Korean medicine, 3.7% for pharmacies, 6.0% for midwifery centers, and 2.7% for public health institutions.
The conversion index increase is 1.45%, and the relative value-linked portion is 0.2%. Hospitals will use 0.1% of their increase to bolster undervalued procedures, and dental and Korean medicine will allocate 0.2% and 0.1%, respectively, to consultation fees and related items.
With this fee adjustment, the health insurance fund is projected to incur an additional 1.2058 trillion won.
The National Health Insurance Service explained that it conducted the talks while weighing both the need to expand support for essential and regional care amid rising medical costs from super-aging and the need to maintain fiscal soundness of the health insurance fund and the care delivery system.
Kim Nam-hun, executive director for benefits at the National Health Insurance Service, said, "This year's fee negotiation environment was far more difficult than during COVID-19 and last year's emergency care situation, as the fund was expected to swing back into deficit, but subscribers, providers, and the service approached the talks in good faith, with the trust and respect, communication, and consideration built up over time."
The Finance Operation Committee recommended that, for the clinic category where talks collapsed, the Health Insurance Policy Deliberation Committee set the fee within the cap of the service's final offer of 1.6%. It also suggested that a significant portion of the funds for clinic-level increases be used to strengthen compensation for essential care and undervalued procedures.
It also adopted an ancillary opinion that related policy tasks—such as expanding Treasury support for health insurance and establishing a legal basis to strengthen the management system for noncovered services—should be expedited.
The negotiation outcome will be finalized after review by the Health Insurance Policy Deliberation Committee next month. Clinic-level fees will be set according to the committee's resolution, after which the Ministry of Health and Welfare is expected to issue a notice on the details by year-end.
Kim said, "Even in a difficult negotiating environment, the service will, after the talks, pursue reasonable improvements to the fee system through a system development council that brings together subscribers, providers, the insurer, the government, and experts, to ensure the sustainability of the health insurance system."