The National Health Insurance Corporation will increase the fees it pays to medical institutions by an average of 1.93% next year. Accordingly, patients' medical costs may rise, and health insurance premiums could also increase.
On the 31st, the National Health Insurance Corporation announced that it had completed negotiations with seven medical associations for the 2026 medical benefit cost contracts and that the results were reviewed and approved by the Financial Operation Committee. This is the first time since 2018 that none of the seven medical associations withdrew and all contracts were finalized.
Medical fees are the compensation for services provided to medical institutions by the government from health insurance funds. They are calculated by multiplying the 'relative value points' determined for each individual service by the 'conversion index.'
The average conversion index increase rate approved that day is 1.93%, slightly lower than this year's (1.96%). Recent conversion index increase rates have been 2.29% in 2020, 1.99% in 2021, 2.09% in 2022, and 1.98% in 2023 and 2024.
The conversion index increase rates for types of medical institutions next year were set at 2.0% for hospitals, 1.7% for clinics, 2.0% for dental clinics, 1.9% for traditional medicine, 3.3% for pharmacies, 6.0% for midwifery clinics, and 2.7% for health institutions. Among these, an additional 0.1% was added to the relative value share for hospitals and clinics.
A health insurance official noted, 'The 0.1% increase in relative value is the second time this has occurred since last year, and it can be seen as providing more compensation to those who were relatively undercompensated.'
As a result of this fee increase, the additional health insurance financial burden is estimated at 1.3948 trillion won. As the financial burden increases, health insurance premiums may also rise.
The National Health Insurance Corporation pays the fees to medical providers from the health insurance premiums collected from subscribers, so the results of the fee negotiations affect the rate of health insurance premium increases.
The Corporation explained that the financial burden has increased due to the freezing of health insurance premiums for the past two consecutive years and the large-scale financial investment in response to the emergency medical system support and essential medical policy initiatives since last year.
The Financial Operation Committee resolved the results of the fee contracts that day and included subsidiary opinions such as compliance with the statutory support rate for national funding for health insurance, the establishment of effective management measures for non-coverage, and the strengthening of government coverage for dental and traditional medicine.
The results of the 2026 medical benefit cost contracts are to be reported next month to the Health Insurance Policy Review Committee, the highest decision-making body for health insurance policy.