Patients with more than 300 outpatient visits a year will pay 90% from next year

Starting next year, patients who receive outpatient care more than 300 times in a year will face a 90% out-of-pocket rate in South Korea. The Cabinet approved the amendment to the enforcement decree of the National Health Insurance Act on the 8th.

The current threshold is more than 365 outpatient visits a year. The government is tightening the standard over concerns that frequent outpatient use can prevent limited medical resources from reaching patients who need care most.

The rule will not apply, as it does not now, to children, pregnant women, and people with severe or rare diseases when outpatient treatment is unavoidable for medical reasons. The National Health Insurance Service may also recognize exceptions after review, even when a patient does not meet the formal exclusion criteria.

The amendment also establishes a system allowing healthcare institutions to check a patient’s use of covered medical services during treatment. At present, one institution may have difficulty seeing treatment records from another, raising concerns that similar tests and treatments could be repeated. The government plans to begin with computed tomography and magnetic resonance imaging services from December 24.