Manual Therapy and Nutritional Injections to Be Restricted... 95% Patient Copayment Rate to Be Applied

Discussion on Establishing a "Non-Covered Services Management System" at the Health Insurance Policy Deliberation Committee
Sustainability to Be Determined Every Five Years by the Appropriateness Evaluation Committee
Strengthened Compensation for Essential Medical Fields Such as Burns, Digit Replantation, and Cerebrovascular Care

The government will designate certain non-covered medical services?such as manual therapy, extracorporeal shock wave therapy, and nutritional injections, which have been cited as major causes of health insurance fund leakage?as "managed benefits" and increase the patient copayment rate to 95%. Compensation will be strengthened for essential medical fields, including burns, digit replantation, childbirth, pediatrics, and cerebrovascular care.

The Ministry of Health and Welfare held the "10th Health Insurance Policy Deliberation Committee of 2025" on May 22 and discussed these measures.

First, the government plans to convert certain excessive non-covered services that could distort the healthcare system or pose risks to patient safety into covered services, establishing clear pricing and treatment standards. Until now, non-covered services have been considered part of the free market, making it difficult to manage the appropriate use of repeatedly provided non-covered services that exceed genuine medical necessity.

However, as concerns have been continuously raised about the need to properly manage non-covered services that are overused beyond medical necessity, especially when combined with indemnity insurance, the government announced in March, as part of the "Second Phase of Healthcare Reform Implementation Plan," that it would establish an appropriate management system for non-covered services with a high risk of overuse.

At the committee meeting, it was decided that certain non-covered services with a high risk of overuse would be newly introduced as "managed benefits," distinct from essential, standard covered services. For these managed benefits, pricing and coverage standards will be set, and a 95% patient copayment rate will be applied, taking into account not only appropriate use management but also social benefits.

The selection of medical practices eligible for managed benefits will be finalized after reviewing data on medical costs, service volume, growth rates, and price variations for each non-covered item. The "Non-Covered Services Management Policy Council," which includes representatives from the medical community, patient and consumer groups, and experts, will comprehensively discuss treatment necessity, social benefits, and financial burden before making a final decision.

For services designated as managed benefits, the government will monitor changes in usage and financial burden annually to assess for any unintended side effects. Every five years, the Appropriateness Evaluation Committee will review and decide whether to continue the managed benefit designation.

A Ministry of Health and Welfare official stated, "By setting clear treatment standards and prices for non-covered services with a high risk of overuse, we can reduce patients' medical expenses and provide appropriate healthcare services. Through the management of non-covered services, we aim to prevent excessive compensation and establish a fair compensation system."

At the same committee meeting, it was also decided that medical institutions specializing in essential services?such as burns, digit replantation, childbirth, pediatrics, and cerebrovascular care?and equipped with specialized capabilities and 24-hour service will receive financial support for providing round-the-clock care. Additional compensation will be provided based on performance indicators such as 24-hour service records, emergency patient acceptance rates, cooperation with tertiary general hospitals, comprehensive secondary hospitals, and local clinics and hospitals.

Until now, even if hospitals provided 24-hour care for specific conditions, they did not receive compensation unless designated as emergency medical centers. However, the government has determined that compensation for essential specialized functions is necessary to ensure that essential medical services are provided to patients in a timely and uninterrupted manner and to support the stable operation of secondary hospitals that fulfill these critical roles.

A Ministry of Health and Welfare official explained, "We will first launch pilot projects for burns and digit replantation, which are areas facing a decrease in supply, as well as for childbirth and pediatrics, where demand is declining, and for cerebrovascular care, where treatment within the golden time is crucial. We plan to continuously identify and gradually expand to other necessary fields. This will help establish a regionally integrated healthcare system in connection with tertiary general hospitals and comprehensive secondary hospitals."