The government will introduce a management system that limits the number of sessions for manual therapy, a representative noncovered treatment. The aim is to bring manual therapy—whose prices vary widely by medical institution and which has faced ongoing controversy over overtreatment—under health insurance management benefits to encourage appropriate care.
The Ministry of Health and Welfare said on the 4th that it convened the Health Insurance Policy Deliberation Committee (Health Insurance Policy Committee) and approved a plan to set managed-benefit fees and coverage criteria for manual therapy.
Manual therapy is a noncovered treatment aimed at relieving musculoskeletal pain and restoring joint function. While some effects are recognized, concerns about misuse have persisted due to its largely selective and adjunctive nature and large price differences among medical institutions. The insurance industry has cited manual therapy as a representative noncovered item that fueled increases in indemnity insurance premiums.
In Feb., the government created the basis to designate noncovered items with concerns of overuse as managed benefits by revising the Enforcement Decree of the National Health Insurance Act. Managed benefits are covered by health insurance, but set the patient copayment rate high at 95% to control medical use.
The Health Insurance Policy Committee set the fee for manual therapy at 43,850 won per session and decided to apply a 95% patient copayment rate. Under this, patients pay about 41,700 won per session and health insurance pays about 2,200 won.
Limits will also be placed on the number of visits. Manual therapy can be received up to twice a week, with an annual allowance in principle of up to 15 sessions. However, in cases where joint contracture or stiffness is evident after surgery or fracture, up to 24 sessions per year will be recognized at the physician's discretion.
In addition, treatment outcomes and clinical details must be recorded mandatorily, and basic physical therapy or simple rehabilitation therapy must be provided first.
The Ministry plans to evaluate the manual therapy managed benefit every three years to review whether to maintain the program and adjust the form of benefits. The Ministry said, "Starting with the introduction of managed benefits for manual therapy, we will gradually strengthen the appropriate management system for noncovered items to reduce the public's medical expenses."
At the meeting, a plan to integrate pilot programs for home-based care, which had been operated separately for seven diseases, into a single program was also discussed.
Programs currently operated separately for type 1 diabetes, home ventilator users, heart disease patients, tuberculosis patients, patients with cancer stoma or urostomy, and rehabilitation patients will be integrated into the "disease-specific home management pilot program." The number of education and counseling sessions will also be increased, and in the field of heart disease, patients with left ventricular assist devices (LVAD) will be newly included.
The results of the performance evaluation of the sickness benefit pilot program were also released. Sickness benefits are a system that supports income for workers who have difficulty working due to nonwork-related illness or injury.
According to the evaluation, beneficiaries felt less anxiety about income loss and medical expenses, and the rate of receiving timely treatment increased by 10.1 percentage points. The rate of continuing to work while ill decreased by 23.3 percentage points. The Ministry plans to review the direction for implementing the main sickness benefit program after collecting opinions from labor and management, the medical community, and experts.
A "rural health clinic fee pilot program" will also be promoted to reduce medical care gaps in rural and fishing communities.
The number of public service physicians in medicine fell from 945 last year to 587 this year. Accordingly, the government will apply separate fees to integrated health subcenters staffed by community health practitioners and pay consulting fees to medical institutions when physicians conduct tele-collaborative care.