The second medical reform implementation plan announced by the government contains a strong will to strengthen the national health insurance system, focusing on non-covered management and essential medical coverage. This announcement concretizes efforts to resolve the increasing burden of medical expenses and excessive non-covered issues, and to expand support for severe and rare diseases.
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[Korean Today] Panoramic view of the Ministry of Health and Welfare building © Reporter Seungmin Hyun |
The health insurance coverage rate in 2023 fell 0.8 percentage points from the previous year to 64.9%. In particular, the coverage rate dropped to 57.3% due to a surge in non-covered flu injections and tests in hospitals. This is a representative case showing the increasing burden of national medical expenses and the need for non-covered management. On the other hand, the coverage rate for serious diseases such as cancer increased slightly to 81.8%. This emphasizes the need to strengthen support for patients with serious diseases and shows that the government’s related efforts are bearing some fruit.
The government has introduced a non-covered reporting system starting in September 2023 to strengthen the non-covered management system. This year, the number of reporting items has been expanded to 1,068, and detailed information such as safety, effectiveness, and substitutability are being disclosed in addition to unit price information. Through this, it is expected that patients will be able to make rational decisions based on reliable information when choosing medical services.
In addition, by strengthening the guarantee for expensive medicines, the financial burden on patients with severe and rare diseases is greatly reduced. For example, the annual treatment cost of Zolgensma, a treatment for spinal muscular atrophy, was reduced from approximately KRW 1.98 billion to KRW 10.5 million through the co-payment cap system. This policy improves accessibility to expensive medicines and provides practical help to patients and their families.
Support for vulnerable groups such as children and the disabled is also continuously being strengthened. Measures such as zero out-of-pocket costs for hospitalization for children under 2 years old and provision of foot braces for disabled children are contributing to reducing blind spots in medical care. In addition, the scope of diseases subject to special calculations will be expanded to 1,314 by 2025, greatly expanding the scope of coverage for patients with severe and rare incurable diseases.
The government aims to curb excessive non-coverage and reduce unnecessary medical use through the reform of the actual loss insurance. The actual loss insurance reform is an important process that can increase the transparency of the medical system and secure the stability of the national health insurance finances in conjunction with the management of non-coverage.
This policy is being promoted with two goals in mind: alleviating the burden of medical expenses and expanding essential medical services. Non-covered management and strengthening essential medical coverage will increase the reliability of the national health insurance system and eliminate blind spots in medical services, providing equal medical benefits to all citizens. If the government’s reform is successfully implemented, the national health care system is expected to become more stable and secure sustainability.
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