Non-covered Medical Expenses Estimated at 22.6 Trillion Won Annually... Implants and Manual Therapy Most Common

Ministry of Health and Welfare and NHIS Announce First Nationwide Medical Institution Statistics
Non-covered Medical Expenses Approximately 1.9 Trillion KRW in March Last Year

In March of last year, the total amount of non-reimbursable medical fees at domestic medical institutions, including tertiary general hospitals, clinics, nursing hospitals, dental hospitals, and Korean medicine hospitals, reached 1.9 trillion KRW. This is the first time that the status of non-reimbursable medical fees across all domestic medical institutions has been aggregated and analyzed. The government plans to announce a second medical reform implementation plan this month, which will include management measures for non-reimbursable treatments that are excessive and non-severe.

According to the '2024 First Half Non-Reimbursable Reporting System' data released on the 6th by the Ministry of Health and Welfare and the National Health Insurance Service, the scale of non-reimbursable medical fees for 1,068 items in March last year was 1.8869 trillion KRW. When annualized, the estimated annual non-reimbursable medical fees amount to 22.6425 trillion KRW.

Non-reimbursable treatments are those not covered by health insurance benefits, requiring patients to bear the full cost of treatment.

By type of medical institution, dental clinics had the largest non-reimbursable medical fees at 741.4 billion KRW (39.3%), followed by clinics with 431.6 billion KRW (22.9%), hospitals with 261.6 billion KRW (13.9%), and Korean medicine clinics with 141.7 billion KRW (7.5%).

By item, in the medical field, manual therapy fees were the largest at 120.8 billion KRW (13.0%), followed by extracorporeal shock wave therapy at 70 billion KRW (7.5%), and single-room premium hospital room fees at 52.3 billion KRW (5.6%). Manual therapy accounted for the largest amounts in both hospital-level and clinic-level institutions, with 51.6 billion KRW and 69.2 billion KRW respectively.

In the dental field, implant-zirconia treatment fees were the largest at 272.2 billion KRW (34.0%), followed by crown-zirconia at 161 billion KRW (20.1%), and fixed comprehensive orthodontics for other malocclusions at 41.9 billion KRW (5.2%).

In the Korean medicine field, herbal decoction and herbal medicine preparations?herbal decoctions accounted for the largest share at 120.9 billion KRW (76.7%), followed by acupuncture therapy?acupoints at 15.1 billion KRW (9.6%), and other herbal decoctions and herbal medicine preparations at 12.8 billion KRW (8.1%).

The non-reimbursable reporting system is designed to guarantee the public's right to know and medical choice by requiring medical institutions to report details of non-reimbursable treatments.

Initially implemented in September 2023 for hospital-level medical institutions, the reporting target was expanded last March to include all medical institutions, including clinics, and the number of reported items increased from 594 to 1,068.

The government plans to comprehensively provide various non-reimbursable related information, including prices by non-reimbursable item, total medical fees, and safety and efficacy evaluation results of non-reimbursable medical practices, through a 'Non-Reimbursable Integrated Portal (tentative name)' within this month. Alongside this, a focused management plan for excessive non-reimbursable treatments that impose burdens on the public’s medical expenses and health insurance finances will be included in the second medical reform implementation plan.

Kwon Byung-gi, Director of Essential Medical Support at the Ministry of Health and Welfare, said, "The non-reimbursable reporting system, first implemented last year, is stabilizing with active cooperation from all medical institutions." He added, "We will discuss expanding the non-reimbursable reporting system and other management measures with experts including the medical community to prepare reform plans that harmonize with a medical system that strengthens essential medical care."