The Ministry of Health and Welfare on the 16th unveiled the outline of stronger national health insurance coverage at a second-half government work briefing held at the Blue House state guesthouse.
It will expand national health insurance support for rare and intractable diseases and for nursing-care costs at long-term care hospitals, and will also review whether to cover treatments for hair loss and severe obesity. In contrast, it also rolled out plans to rein in duplicate CT and MRI scans and sham care to reduce national health insurance expenditure.
The idea is to broaden coverage while saving finances. The issue is priorities. Where to allocate limited national health insurance funds first has emerged as a new sticking point.
First, for patients with high medical and nursing-care needs, national health insurance will cover nursing-care costs at long-term care hospitals. Patients' out-of-pocket burden will be lowered from the current 100% to around 30%, and the plan will be phased in starting next year. The eligible population will be expanded to 85,000 by 2030. The designation criteria for medically focused long-term care hospitals and the exact out-of-pocket rate will be finalized later.
Support for rare and intractable diseases will also be expanded. The listing period for treatments on national health insurance will be shortened from 240 days to 100 days, and the special-case out-of-pocket rate will be lowered in stages. The price of generics will be cut by 15.7% for the first time in 14 years. Sickness benefits will move toward legalization in 2027 after a pilot program.
The review of adding coverage for treatments for hair loss and severe obesity will also continue. Minister Jung Eun-kyeong of the Ministry of Health and Welfare said at a pre-briefing the previous day, "We are preparing a plan to strengthen national health insurance coverage by comprehensively considering the demand to cover new health issues such as hair loss and severe obesity."
However, another pillar the government presented at this work briefing is reducing national health insurance finances. It aims to save 2.6 trillion won a year by cutting duplicate CT and MRI scans and overtreatment.
With not a few cases in which even treatments for rare diseases are waiting to be listed on national health insurance, if treatments for hair loss and severe obesity are also included in coverage, how to set priorities and by what standards is expected to test the policy.
The first target for savings is duplicate tests and overtreatment. To reduce repeated CT and MRI scans when patients switch hospitals, the ministry will build a system in December this year to query imaging histories across medical institutions in real time. In the first half of next year, it will also establish a sharing framework that lets patients transmit medical images to other hospitals via QR code. It will provide incentives for reading images from other hospitals and is reviewing additional measures to cut unnecessary rescans.
Crackdowns on sham care will also be strengthened. Authorities are conducting administrative investigations into so-called "paybacks" that refund part of medical bills to cancer patients, excessive prescriptions of ADHD treatments, and broker-run hospitals. Starting in August, they will launch a planned probe and toughen sanctions, including business suspensions and penalty surcharge imposition, when violations are uncovered.
Saved finances will be invested in regional and essential care. Starting in 2027, the government will create a special account for regional essential care worth 1.2 trillion won per year, and will undertake a full overhaul of the national health insurance fee schedule for the first time in 25 years to invest 3.6 trillion won annually in regional and essential care. National university hospitals will be fostered as final treatment centers for severe and highly complex diseases, and local public hospitals will strengthen capabilities in emergency, surgery, and critical care. The contract-based regional essential physician system will be expanded nationwide, and the regional physician system, the establishment of a national medical graduate school, and the creation of new regional medical schools will be pushed forward in stages.
Healthcare innovation using artificial intelligence (AI) will also accelerate. National bio big data and clinical data from national university hospitals will be opened to researchers, and an "AI basic healthcare strategy" spanning prevention through treatment and emergency care will be released this month. A pharma-bio megafund will be created at a scale of 1 trillion won to nurture flagship national technologies.