South Korea to lower fees for profitable scans, boost essential medical services

South Korea's Ministry of Health and Welfare announced plans to overhaul the national health insurance fee structure, aiming to rebalance compensation towards essential medical services. The reform will involve reducing fees for high-revenue diagnostic procedures like blood tests, CT scans, and MRIs, while simultaneously increasing payments for critical care.

The ministry estimates that adjusting the fees for tests where revenue significantly exceeds costs, specifically, blood tests with over 190% profit and MRI/CT scans with around 200% profit, will generate over 2 trillion won (approximately $1.45 billion) annually. This revenue will be reinvested into strengthening regional and essential medical services, which are currently less compensated. For instance, compensation for consultations stands at 70.7%, inpatient care at 57.3%, surgeries at 105.7%, and anesthesia at 75.1%.

In the first phase, the government intends to lower the fees for tests where the cost-to-revenue ratio exceeds 150%, bringing their profitability down to that level. A further analysis in 2028 will determine if additional adjustments are needed. The generated funds will be prioritized for services deemed essential, including critical care, emergency treatment, pediatrics, and obstetrics, with a particular focus on underserved regions. The plan includes establishing preferential fee rates for non-metropolitan areas and vulnerable regions.

Beyond diagnostic imaging and lab tests, the reform also targets an increase in remuneration for direct patient care. The ministry aims to shift from short consultations (around three minutes) to more in-depth patient discussions and counseling, enhancing the quality of care. The final plan, incorporating feedback from a public hearing, is expected to be finalized and announced by the end of June.

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We will significantly innovate health insurance to focus on regional and essential medical services, ensuring that people can receive quality essential medical services anytime, anywhere.