The government will inject 3.6 trillion won in health insurance finances annually into regional and essential care. It will overhaul the health insurance reimbursement structure to curb excessive expenditure arising from computed tomography (CT) and magnetic resonance Gong Myoung (MRI), and strengthen compensation for regional and essential care.
The Ministry of Health and Welfare convened the Health Insurance Policy Deliberation Committee on the 25th and finalized a reform plan to overhaul the health insurance reimbursement structure. The reimbursement refers to the money the National Health Insurance Service pays hospitals. The aim is to raise reimbursements in areas such as regional, emergency, delivery, and pediatrics to deter clinicians from shunning them and to ensure people can receive needed treatment anywhere. The reform plan is slated to take effect as early as the end of this year.
The government will apply regional preferential reimbursements to six vulnerable areas outside the Seoul metropolitan area and in Uijeongbu, Namyangju, and Icheon in Gyeonggi. Until now, reimbursements were the same regardless of region. Going forward, all surgeries and procedures at general hospitals and above in those areas will receive a 10% add-on. Nights, holidays, and emergencies will get an additional 10% add-on. Pediatric intensive care units will receive a 50% add-on.
Office visit fees will be raised for the first time in 20 years. For first-time visits to local clinics, the visit fee will increase by 6%. Follow-up visits will rise by 4%. At hospitals and above, both initial and follow-up visit fees will increase by 2%. General wards and intensive care units will see inpatient reimbursement rates rise by 7% and 10%, respectively. In 84 city, county, and district areas with declining populations, visit and inpatient fees will receive a 5% add-on. For in-depth consultations of 15 minutes or more for pediatric patients and others, sufficient compensation will be ensured.
Compensation for severe, emergency, and definitive treatment will also be expanded. At general hospitals and above, reimbursement for some 1,600 cardiovascular, cerebrovascular, cancer, and other surgeries will be raised by 20%. For emergency patients admitted to regional emergency medical centers on holidays or at night, surgery reimbursement will be increased 5.5-fold. Compensation will be strengthened not only for surgeries and procedures but also for anesthesia.
Support for mother-child centers will be expanded so that high-risk pregnant women can deliver with confidence. Mother-child centers are hospitals equipped with medical staff and equipment for mothers and newborns and are classified as regional (primary), area (secondary), and severe (tertiary). When a baby born before 28 weeks is delivered at a severe mother-child center, an additional 4.4 million won will be paid. For mother-child centers outside the Seoul metropolitan area, an additional 5.06 million won will be paid. Basic pregnancy and delivery reimbursement will be raised by 20%, and high-risk deliveries will receive add-ons of 100% to 200%.
To strengthen pediatric care, the age for add-ons to visit fees will be raised from under 6 to under 8. When severe procedures are needed in pediatric intensive care units, a 50% add-on will be applied. Outside the Seoul metropolitan area and in vulnerable areas within it, a 100% add-on will be applied. Moonlight Children's Hospitals located in city, county, and district areas with small pediatric populations will receive a 30% add-on for nighttime visit reimbursement. In addition, the emergency medical system will be strengthened from the acute to the recovery phase.
The government plans to secure resources by adjusting existing CT, MRI, and specimen test reimbursement. According to the Ministry of Health and Welfare, as of 2023, CT and MRI had average revenue exceeding 200% relative to expense. Specimen tests were found to be around 190%. The government plans to gradually lower reimbursements for CT, MRI, and specimen tests. It said this could reduce expenditure by 2.6 trillion won annually. Minister Jung Eun-kyeong of the Ministry of Health and Welfare said, "We will ensure people can receive emergency treatment swiftly in regional areas as well."