The Ministry of Health and Welfare will apply national health insurance to the mitral transcatheter edge-to-edge repair using clips (M-TEER) for patients with severe mitral regurgitation for whom surgery is difficult or carries high risk. The noncovered procedure cost that had been as high as 40 million–50 million won will drop to about 1.4 million won for patients eligible for the catastrophic illness program after insurance coverage.
The ministry said on the 30th that it has prepared insurance coverage criteria reflecting this and will implement them starting on the 31st.
The new coverage is intended to improve access to treatment for patients with severe mitral regurgitation who cannot undergo conventional surgery or whose symptoms do not improve with medication.
Mitral regurgitation is a condition in which the heart's mitral valve does not close properly, causing blood to flow backward. If left untreated, it can lead to heart failure, but older patients or those with underlying conditions faced high risks with open-chest surgery, making treatment difficult.
The newly covered "clip procedure" involves inserting a catheter through a femoral blood vessel and securing the mitral valve with a clip to reduce regurgitation. Because it does not require opening the chest, the surgical burden is relatively lower.
According to the ministry, the number of mitral regurgitation patients in Korea is estimated at about 25,000 as of last year. Patient groups and others have steadily called for national health insurance coverage of the procedure, which has been a high-cost, noncovered service.
Coverage eligibility is divided by the cause of the condition.
For primary mitral regurgitation, which arises from abnormalities of the valve itself, if the heart team determines surgery is not possible, the catastrophic illness program applies with a 5% coinsurance. Patients at high surgical risk are eligible for selective coverage (50% coinsurance).
For secondary mitral regurgitation, which occurs due to impaired cardiac function, if the heart team unanimously agrees that surgery is difficult or high risk, the ventricular type is covered (5% coinsurance) and the atrial type receives selective coverage (80% coinsurance).
The new coverage will significantly reduce patient costs. Currently, because expensive treatment materials are used, the noncovered cost is 40 million–50 million won. After insurance coverage, the total medical bill at a tertiary general hospital will be recognized at about 28.3 million won, and patients eligible for the catastrophic illness program will pay only about 1.4 million won.
The ministry will also expand compensation for heart team care. When the procedure is performed through heart team care—where specialists such as cardiothoracic surgeons and cardiologists jointly determine the treatment plan—a separate team-care fee will be recognized.
In addition, to continuously manage the appropriateness of patient selection and treatment outcomes, the government will build a clinical registry and ensure that procedures are performed at medical institutions with capabilities above a certain level.
Yu Ju-heon, director general for health insurance policy at the ministry, said, "Until now, patients with mitral regurgitation for whom surgery is difficult or high risk had to undergo the procedure at their own full expense, but with this coverage we expect more treatment opportunities and a substantial reduction in out-of-pocket medical costs," adding, "We will continue to expand health insurance coverage for new medical technologies."