The National Health Insurance Service (NHIS) announced on the 1st that it has completed negotiations for the 2024 medical fee schedule contract with seven organizations, including the Korean Medical Association, and that the Health Insurance Financial Management Committee reviewed and approved the agreement on the same day.
As a result of the negotiations, the medical fees for next year will increase by an average of 1.98%. The additional required budget is estimated at 1.1975 trillion KRW. This figure reflects the finalized increase rates of five organizations (Hospitals 1.9%, Dentistry 3.2%, Korean Medicine 3.6%, Midwives 4.5%, Public Health Institutions 2.7%), while for the types of clinics and pharmacies where negotiations ultimately broke down, the NHIS applied the final proposed increase rates of 1.6% and 1.7%, respectively. According to the National Health Insurance Act, the increase levels for clinics and pharmacies that failed to reach an agreement in this negotiation will be decided by the Health Insurance Policy Deliberation Committee by the 30th of this month. Subsequently, the Minister of Health and Welfare is expected to announce the “Details of the 2024 Health Insurance Medical Fee Schedule” by the end of the year. The fee increase will also affect the health insurance premium rate, which exceeded 7% for the first time last year.
This year’s negotiations were expected to be difficult due to the differing perspectives between subscribers, who complained about the recent rapid inflation and economic burdens, and providers, who demanded bold financial investment to address management difficulties caused by rising medical costs. Ultimately, clinics and pharmacies failed to reach an agreement. Clinics faced a breakdown for the second consecutive year and received the lowest final increase rate of 1.6% among the seven organizations from the NHIS. Pharmacies, having received a 3.6% increase in 2022?2023, requested the same increase level for three consecutive years, but are expected to receive a significantly reduced increase rate of 1.7%. On the other hand, Korean Medicine, which had a breakdown last year and received a 3.0% increase, succeeded in raising the increase rate to 3.6%.
For this negotiation, the NHIS diversified the fee adjustment models to reflect the current healthcare situation and economic conditions and to objectively set the fee bands. Along with the existing “Sustainable Growth Rate (SGR) model,” four improved models including the Gross Domestic Product (GDP) model were presented as results. Additionally, before the negotiations, a communication meeting among subscribers, providers, and the NHIS was held to listen to voices from the medical field and exchange opinions.
Lee Sang-il, the NHIS negotiation team leader and Executive Director of Benefits, expressed regret over the breakdown in negotiations with clinics and pharmacies despite multiple consultation processes aimed at resolving the perspective gap between subscribers and providers. He also stated that efforts were made to ensure smooth negotiations based on mutual trust and respect, considering comprehensively the sustainability of the health insurance system, the establishment of an essential medical system, the maintenance of medical infrastructure that guarantees the lives and safety of the public, and the burden level on subscribers amid difficult economic conditions. Furthermore, he expressed gratitude for the dedication of the medical community in overcoming the national disaster situation caused by COVID-19, while emphasizing that the economic burden on subscribers due to recent high inflation and the sustainability of health insurance finances had to be taken into account as well.
© The Asia Business Daily(www.asiae.co.kr). All rights reserved.
