An orthopedic clinic in Dobong District, Seoul, shut down its physical therapy room on Aug. 29. It had offered manual therapy and extracorporeal shock wave therapy, but after manual therapy was shifted to managed benefits, profitability fell, and the clinic ultimately closed the physical therapy room.
A clinic in Seoul that provides internal medicine and orthopedics also stopped physical therapy in July. The clinic's lead physician, identified as A, said, "With only basic physical therapy, it's hard even to pay staff salaries," and added, "We had covered operating costs with non-reimbursed items such as manual therapy, but as fees fell to less than half and caps on visits were imposed, it effectively went into the red."
◇ "The more we operate, the more we lose"… Hospitals and clinics cut back physical therapy rooms
Since manual therapy was incorporated into managed benefits, orthopedic surgery and rehabilitation medicine clinics have been reducing the size of their physical therapy rooms or suspending operations. As the number of patients receiving manual therapy and the number of sessions declined, the trend spread to job insecurity among physical therapists.
Working physical therapists are feeling the change. B, a 29-year-old physical therapist working in Cheongju, North Chungcheong Province, said, "After the shift to managed benefits, the number of patients coming in for manual therapy has visibly decreased," and noted, "Hospitals are also trimming back the scale of manual therapy, and some physical therapists who mainly handled manual therapy have quit."
As the manual therapy market shrinks, some hospitals are seeking new revenue sources. The hospital where B works is said to be preparing a specialized program that combines obesity treatment and exercise programs, using Mounjaro instead of manual therapy.
◇ Manual therapy insurance claims plunge 78%… Users also "drop"
The decline in manual therapy use after the introduction of managed benefits also showed up in insurance claims. According to Samsung Fire & Marine Insurance(000810), the average daily insurance claims for manual therapy fell about 78%, from around 450 million won in the first half of this year (January–June) to around 100 million won this month.
To curb excessive non-reimbursed care, the government last month shifted manual therapy, a representative non-reimbursed item, into managed benefits. Manual therapy is a treatment in which a physical therapist uses hands or tools to ease musculoskeletal pain and help restore joint function. It had been offered as a non-reimbursed service, leading to large price differences among medical institutions, and drawing criticism over overuse at some institutions and excessive claims under indemnity insurance.
Managed benefits is a system to manage, within the national health insurance framework, non-reimbursed items with a high risk of overuse. For manual therapy, patients pay 95% of the medical bill and national health insurance covers the remaining 5%. The patient share is 41,657 won per session, and the health insurance support is 2,193 won.
There is also a cap on the number of sessions. In principle, managed benefits apply up to twice a week and 15 times a year. If joint contracture or stiffness is evident after surgery or fracture, up to 24 sessions may be allowed at the physician's discretion.
◇ As patients dwindle, incentives also plunge… Physical therapists' pay takes a direct hit
The decline in manual therapy use is directly affecting physical therapists' income. Physical therapists typically receive a base salary plus incentives tied to treatment performance such as manual therapy or extracorporeal shock wave therapy. While it varies by hospital, it is known that some receive roughly 10%–15% of treatment costs as incentives. When the number of manual therapy patients and sessions decreases, incentive income is bound to fall.
At some hospitals, as physical therapy rooms are downsized, there have been cases of proposing voluntary resignation to physical therapists.
A person surnamed Kim in their 30s, who worked as a physical therapist for 10 years, is now also preparing to apply to a public medical institution. Kim said, "Before managed benefits were introduced, my monthly pay was in the mid-to-high 3 million won range, but last month it dropped sharply to the 2 million won range," and added, "Given that the pay structure is unlikely to improve, I figured working at a public institution with greater job stability would be better for my life."
◇ "Fewer jobs and weakened expertise"… Physical therapists call for policy fixes
According to the Ministry of Health and Welfare and others, about 50,000 physical therapists are active in Korea. Around 4,000 people newly obtain physical therapist licenses each year. As the manual therapy market contracts, concerns are rising that this could hurt their employment and income.
The Korea Physical Therapy Association says job insecurity among physical therapists is growing and has begun identifying cases and providing support. The association's Gyeonggi chapter is conducting a public petition calling for improvements to the managed benefits system for manual therapy. The association argues that due to the policy changes, physical therapists are experiencing job losses, job insecurity, and weakened expertise.
Before the system took effect, starting in June, the Gyeonggi chapter also provided support from a Certified Public Labor Attorney and consultations on employment damage for physical therapists who had been asked to resign. The association said, "Recently, related consultations and reports have been increasing," and added, "We judge that on-the-ground difficulties are growing."