Surgical Fees for Cerebrovascular and Abdominal Aneurysms Increased Up to 2.7 Times... 66 Additional Designated Rare Diseases Added

Coverage of Obstructive Hypertrophic Cardiomyopathy and Neuroblastoma Treatments Approved by Health Insurance Committee
First Consultation Fee Support for High-Risk Groups in National Mental Health Screening

The government will significantly increase the surgery fees for cerebrovascular and abdominal aortic aneurysm surgeries by up to 2.7 times starting next year to ensure fair compensation in essential medical fields. Additionally, 66 new rare diseases have been added to the special calculation system for rare diseases, which helps alleviate medical expenses for patients with rare and severe incurable diseases.

On the 28th, the Ministry of Health and Welfare held the '23rd Health Insurance Policy Deliberation Committee Meeting of 2024' and approved ▲ improvement plans for surgery fees related to cerebrovascular and abdominal aortic aneurysm surgeries ▲ support for the first medical expense co-payment for follow-up management of mental health examinations included in the national health screening ▲ revision of the drug benefit list and maximum benefit price table (new drug listings), and discussed ▲ expansion of rare diseases eligible for the special calculation system.

First, starting January next year, surgeries for cerebrovascular and abdominal aortic aneurysms will be subdivided based on the surgical site, whether the blood vessel is ruptured, and whether lobectomy is performed, with relative value points increased by up to 2.7 times according to risk and difficulty.

Emergency surgeries such as craniotomy or trephination to relieve increased intracranial pressure caused by cerebral hemorrhage or brain tumors, and abdominal aortic aneurysm surgeries for abnormally enlarged abdominal aortas that have a high risk of rupture and death, are considered essential yet avoided medical fields. A Ministry of Health and Welfare official explained, "To strengthen the medical foundation through fair compensation in essential medical fields, we will significantly increase the fees for these surgeries. Strengthening compensation for high-risk and high-difficulty medical procedures will contribute to maintaining infrastructure such as personnel in essential medical fields and resolving blind spots in medical care."

Additionally, starting January next year, if a mental health examination included in the national health screening identifies a risk group for depression or early psychosis, the co-payment for the first medical visit will be supported to enable accurate diagnosis at medical institutions.

Currently, depression screening is included in the health screening items, with individuals aged 20 to 34 screened once every two years, and other age groups once every ten years. However, only 17.8% of newly identified mental health risk groups through screening proceed to treatment. Therefore, the government expects that by supporting the first medical expense for those identified as risk groups in mental health examinations within the national health screening, early detection and treatment of mental illnesses will be possible, preventing chronic conditions.

The list of rare diseases eligible for the special calculation system for health insurance co-payments has also been expanded. The special calculation system reduces the cost burden for patients with severe diseases such as cancer and rare or severe incurable diseases by lowering the out-of-pocket expenses borne by patients. Typically, the health insurance co-payment rate is about 20% for inpatient care and 30-60% for outpatient care, but under the special calculation system, patients pay only 0-10% for both inpatient and outpatient care.

At the committee meeting, 66 diseases were added to the special calculation system, including two newly designated national management rare diseases such as achalasia (a disease where esophageal peristalsis decreases or the lower esophageal sphincter fails to relax, preventing food from passing), 59 ultra-rare diseases (with a patient population of 200 or fewer), and five other chromosomal abnormality diseases. As a result, the total number of rare diseases under the special calculation system increased to 1,314.

Meanwhile, starting next month, health insurance coverage will be applied to Camzios (active ingredient mavacamten), a treatment for obstructive hypertrophic cardiomyopathy patients to improve exercise function and symptoms. Until now, treatments such as beta-blockers and calcium channel blockers, used for hypertension and arrhythmia, were recommended to alleviate symptoms, but patients who did not respond or experienced severe side effects faced treatment difficulties.

However, with the recent development and insurance coverage of a treatment that improves exercise function and symptoms for obstructive hypertrophic cardiomyopathy patients, treatment accessibility has increased and economic burdens have been reduced. Notably, this disease is eligible for the special calculation system, so patients using Camzios will have a 10% co-payment rate. Currently, the annual medication cost per patient, which was about 22.49 million KRW, will be reduced to approximately 2.25 million KRW.

Additionally, at the Health Insurance Policy Deliberation Committee meeting held on the 18th, 'Quajivazoo' (active ingredient dinutuximab beta), a treatment for neuroblastoma patients, was selected as a 'pilot project drug for approval-evaluation-negotiation.' This pilot project supports the rapid listing of treatments for severe diseases by simultaneously conducting the Ministry of Food and Drug Safety approval, Health Insurance Review and Assessment Service benefit evaluation, and National Health Insurance Service negotiation. As a result, Quajivazoo was covered by health insurance just 5.5 months after drug approval by the Ministry of Food and Drug Safety, providing patients with rapid treatment opportunities.

This drug's benefit criteria were set to cover neuroblastoma patients aged 12 months to under 20 years who previously showed partial response or worse after induction chemotherapy and have a history of hematopoietic stem cell transplantation, as well as recurrent or refractory neuroblastoma. Until now, neuroblastoma patients had to bear an annual medication cost of about 350 million KRW per person, but with this health insurance coverage, the cost will be reduced to about 10.5 million KRW (5% co-payment, with co-payment ceiling applied).