The Ministry of Health and Welfare’s Kwon Byung-ki, director of essential medical support, said that the non-covered management plan and the actual loss insurance reform plan will be comprehensively reflected by collecting various opinions through future discussions . This announcement was made amid a slight decrease in the health insurance coverage rate in 2023 compared to the previous year . The coverage rate decreased by 0.8 percentage points from 65.7% to 64.9% , and the increase in non-covered treatment at medical institutions at the level of hospitals was identified as the main cause . In particular, the coverage rate at hospitals fell by 3.4 percentage points to 57.3% due to a sharp increase in the number of non-covered injections and tests related to influenza .
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[Korean Today] Ministry of Health and Welfare © Reporter Han Ji-min |
Even in hospital-level medical institutions, the increase in non-covered items contributed to the decrease in the coverage rate , and with the addition of new non-covered items such as intra-articular injection of bone marrow aspirate, the coverage rate decreased by 1.2 percentage points to 50.2% . However, the coverage rate for the four major severe diseases including cancer increased by 0.3 percentage points to 81.8% , and the coverage rate for the top 30 diseases in terms of medical expenses also increased by 0.4 percentage points to 80.9% , showing an increasing trend in health insurance coverage for severe diseases .
These changes imply that in order to ease the burden of national medical expenses, it is necessary to simultaneously pursue non-covered management, actual loss insurance reform , and strengthening the coverage of essential medical care . In the first implementation plan for medical reform announced in August of last year, the government promised to strengthen non-covered monitoring, expand information provision , and promote non-covered standardization . The reporting items of the non-covered reporting system implemented since September 2023 are continuously expanding , and are expected to increase to 1,068 items by 2024 .
Disclosure of information on non-covered items is moving away from unit price-centered provision and toward supporting patients’ rational choices in areas such as safety , effectiveness , and substitutability . Standardization work is underway for optional non-covered items through the assignment of standard codes and names . The government plans to establish a plan to manage excessive non-covered items and reform actual loss insurance through discussions with the medical community and experts .
In addition , according to the 2nd National Health Insurance Comprehensive Plan established in February of last year, we will continue to strengthen coverage, focusing on essential medical fields such as severe and rare incurable diseases, in order to provide essential medical services in a timely manner to promote national health . To this end, various efforts are being made, such as strengthening pharmaceutical coverage to reduce the burden of expensive drug costs , strengthening coverage for vulnerable groups such as children and the disabled , and expanding the target diseases for special calculations .
As of December 2024, approximately KRW 1.45 trillion in health insurance finances are expected to be invested . Recent examples of strengthening coverage in essential medical fields include strengthening pharmaceutical coverage to ease the burden of drug costs for cancer and rare intractable diseases . For example , in the case of Zolgensma, a spinal muscular atrophy treatment, the patient’s share decreased from KRW 1.98 billion to KRW 198 million , and for Leclaza, a non-small cell lung cancer treatment, it decreased from KRW 68.7 million to KRW 3.43 million .
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[Korean Today] Case of strengthening coverage in essential medical fields © Reporter Han Ji-min |
In addition , measures to support vulnerable groups have been implemented, such as providing continuous blood glucose monitoring for patients with type 1 diabetes , providing foot orthotics for disabled children , and eliminating out-of-pocket expenses for hospitalization for children under 2 years old . Efforts to eliminate blind spots in medical care include expanding the target of special calculations for severe and rare incurable diseases . The introduction of home rehabilitation services and the expansion of criteria for supporting the social reintegration of patients discharged from nursing hospitals are also part of these efforts .
Kwon Byeong-gi, the director of the Essential Medical Support Office, emphasized, “ We plan to hold discussions in the future to gather diverse opinions from various circles on non-covered care management measures and actual loss insurance reform measures, and comprehensively reflect them in the second medical reform implementation plan, ” adding , “ We will also continue to work to strengthen health insurance coverage for essential medical care areas . ”
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