The government will increase the health insurance reimbursements for over 1,000 medical procedures in pediatric and emergency medicine. This is to address the low reimbursement structure in essential medical fields and the imbalance in health insurance rates. The government plans to increase the number of items for reimbursement increases to over 2,000 by 2027 and to accelerate the reimbursement increase rate for low-reimbursement items.
The Ministry of Health and Welfare stated on the 27th that it held the '6th Health Insurance Policy Advisory Committee' in the International Electronics Center in Seocho, Seoul, to review this year's implementation plan for the '2nd Comprehensive Plan for National Health Insurance.'
This year's implementation plan includes the 2nd year action plan of the 2nd Comprehensive Plan for National Health Insurance announced in February last year. It plans to promote 75 detailed tasks to strengthen essential and community healthcare and to build a sustainable health insurance system.
First, to increase the supply in essential medical fields and strengthen compensation, it will focus on increasing the reimbursement for over 1,000 procedures with low reimbursement for surgeries, treatments, and anesthesia. Following last year's increase in reimbursements for severe heart disease, kidney transplants, and cerebrovascular and abdominal aortic surgeries, from April this year, it will expand the added reimbursements for percutaneous arterial duct occlusion, external auditory canal reconstruction, and malignant bone tumor surgeries. The reimbursement for extensive cervical conization will be newly established.
To strengthen compensation for pediatric surgeries, it will enhance compensation for high-difficulty medical procedures, including age-based increases for severe pediatric surgeries. The ministry will continue to implement the 'Alternative Payment System Pilot Project,' which adjusts compensation based on the quality and outcomes of care rather than the quantity of services.
Efforts to close regional medical disparities will be made by strengthening the capabilities of local medical institutions and expanding integrated support for medical care and nursing. It will provide 26 billion won in labor costs to national university hospitals and regional general hospitals, and 81.5 billion won for facilities and equipment, and will operate a low-interest loan budget of 120 billion won to support hospital investment financing.
The capability enhancement of local hospitals will focus on essential and community healthcare. In particular, it will prioritize projects to strengthen abdominal surgical capabilities for emergency patients. It will provide additional reimbursement and regional support funds to local hospitals capable of performing emergency abdominal surgeries 24 hours a day. If an emergency abdominal surgery is performed, the surgery and related anesthesia reimbursements will be increased by 100%. The emergency treatment reimbursement for regional emergency medical centers will also be increased by 100%, allowing for a maximum additional reimbursement of 200%. In regions lacking emergency surgery infrastructure, differentiated regional support funds of up to 300 million won will be provided.
The ministry noted, "Through this pilot project, we will strengthen the emergency surgical capabilities of local hospitals and support them to establish necessary infrastructure," adding, "Starting with emergency abdominal surgeries, we will ensure that necessary surgeries are performed in a timely manner."
Additionally, it will continue to promote pilot projects for personal physicians for people with disabilities and dental care to address gaps in medical services, and it will expand insurance coverage for treatments for severe and rare diseases. The new coverage scope is expected to include 20 items, with 10 items anticipated to broaden the scope of coverage. The government expects that this expansion of coverage will enhance medical access for vulnerable groups.
It will also pursue improvements in the medical supply system through stabilizing the supply chains of essential medicines and therapeutic materials. By the first half of this year, it will introduce a pricing policy favoring domestically produced essential medicines. The aim is to establish a supply system centered on domestic raw materials to resolve supply instability. Prices for new drugs developed by pharmaceutical companies with a high research and development (R&D) ratio will also be favored to support domestic new drug development.