The government will move to adjust National Health Insurance fees for specimen tests and computed tomography (CT) and magnetic resonance imaging (MRI) scans. It plans to save more than 2 trillion won a year in health insurance finances while strengthening compensation for essential medical fields such as regional care, emergency care, pediatrics, and childbirth.
The Ministry of Health and Welfare on the 17th held a "public hearing on innovation of the National Health Insurance fee structure" at the President Hotel in Seoul and unveiled a "plan (draft) to innovate the National Health Insurance fee structure to strengthen regional and essential medical care" that includes these measures.
The overhaul focuses on reallocating health insurance finances toward regional and essential medical care. While expanding compensation for non-capital areas, medically underserved regions, and severe, emergency, pediatric, and maternal and child care, the government will adjust fees for tests where it judges compensation has been excessive.
According to the Ministry, an analysis by the National Health Insurance Service of 2023 accounting data from tertiary general hospitals, general hospitals, and clinics found that revenue versus expense for specimen tests averaged about 190%, and CT and MRI scans averaged about 200%.
As a first step, the government plans to adjust fees for specimen tests and CT and MRI scans with revenue versus expense exceeding 150% down to around 150%. Then, in 2028, two years later, it will further analyze revenue versus expense and make additional adjustments toward a balanced fee system.
The Ministry estimated that this first-round adjustment will generate annual health insurance savings of about more than 2 trillion won.
Using the savings, support for regional and essential medical fields will be expanded.
First, the government will establish and gradually expand the principle of regional preferential fees for non-capital regions and vulnerable areas within the capital region. The aim is to strengthen medical capacity so patients can be treated for emergencies and severe conditions within their regions.
Compensation for major surgeries and anesthesia will also increase. In particular, even for the same surgery, compensation will be higher when performed in an emergency, to bolster final treatment capacity for emergency patients.
Support for pediatric and maternal and child care will be strengthened. Reflecting the distinct nature of pediatric care compared with adult care in insurance fees, the government will raise compensation from primary care to severe pediatric surgeries and procedures. To enhance capacity for high-risk deliveries and neonatal care, it will also pursue fee support linked to a functional reorganization of maternal and child care centers.
The plan also includes an overhaul of the outpatient care system. The government will raise the level of consultation fees, which have been frozen for roughly 20 years, and strengthen compensation for in-depth counseling and in-depth consultations to shift from brief visits of around three minutes to care centered on sufficient counseling.
Compensation will also be expanded for rehabilitation care. The plan is to support building a rehabilitation care delivery system that connects recovery-phase rehab after treatment to at-home care after discharge.
Minister Jung Eun-kyeong of the Ministry of Health and Welfare said, "By establishing a National Health Insurance fee principle that favors regions, we will ensure that when emergencies occur in the regions, people can swiftly access care and the public can receive high-quality essential services anytime, anywhere," adding, "To that end, we will make sweeping innovations to focus health insurance on regional and essential medical care."
The Ministry will incorporate feedback from the public hearing and, after preparing the plan to innovate the National Health Insurance fee structure to strengthen regional and essential medical care, will finalize and announce it at the end of this month following deliberation by the Health Insurance Policy Deliberation Committee.