The South Korean government announced plans to reclassify certain non-critical and uninsured medical treatments. (Image courtesy of Yonhap)
SEOUL, Jan. 10 (Korea Bizwire) — In a significant healthcare reform initiative, the South Korean government announced plans to reclassify certain non-critical and uninsured medical treatments, including manual therapy, under a new “managed care” category that will require patients to pay over 90% of the costs.
The policy change, unveiled at a public forum on healthcare reform at the Korea Press Center on January 9, aims to curb excessive medical treatments and rising healthcare costs. Under the new system, patients with private actual cost reimbursement insurance – policies that cover medical expenses not fully covered by the Korean National Health Insurance (NHIS) – will not be able to receive coverage for non-essential treatments that are deemed susceptible to overuse.
The government will also restrict national health insurance benefits when unnecessary combinations of covered and uncovered treatments are performed simultaneously. The reform extends to the upcoming “fifth-generation” actual cost reimbursement insurance policies, which will focus coverage on critical illnesses while reducing benefits for non-critical and uninsured treatments.
The new “managed care” system will allow authorities to set standardized prices and treatment criteria for services that are currently uninsured and priced differently across medical facilities. Priority will be given to treatments that show sudden increases in volume or significant price variations between healthcare providers.
While specific treatments haven’t been finalized for the new category, manual therapy – currently the most expensive uninsured treatment – along with shock wave therapy and vitamin injections are likely candidates.
The reform package includes the creation of a comprehensive online portal for uninsured medical services, where patients can compare nationwide prices and access information about treatment safety, effectiveness, and covered alternatives. Healthcare providers will be required to obtain patient consent after explaining treatment costs, reasons for prescription, and alternative therapies.
For the new fifth-generation actual cost reimbursement insurance policies, coverage will initially focus on critical illnesses, with plans for non-critical treatments to be introduced after June 2026. When launched, these plans will reduce coverage limits for non-critical uninsured treatments from 50 million won to 10 million won, while increasing patient copayments from 30% to 50%.
The government also plans to incentivize early-generation insurance policyholders to switch to new plans through a compensation program, as part of its broader strategy to fundamentally reform the actual cost reimbursement insurance system.
Under the new system, general outpatient services will require patient copayments of 30-60%, matching national health insurance rates. This represents a significant increase from the current system, where patients typically pay 6-12%. However, patients with serious conditions such as cancer, cerebrovascular diseases, cardiac conditions, and rare diseases will maintain the current minimum copayment rate of 20%.
The new insurance policies will also include coverage for pregnancy and childbirth-related expenses, which were previously excluded.
M. H. Lee (mhlee@koreabizwire.com)
