Strengthening Essential Healthcare Coverage for Rare Disease Patients Through Expansion of Special Cost Reduction Program

NHIS Expands Benefits to 70 New Rare Diseases Including "ARHGEF9-Related Disorders"
Number of Diagnostic Institutions Increased to 44 to Strengthen Healthcare Accessibility

The National Health Insurance Service announced on January 6 that it will expand the list of rare diseases eligible for special cost reduction and designate additional diagnostic and treatment institutions, in order to lower medical expenses and improve healthcare accessibility for patients with rare diseases.

The special cost reduction program is a system that lowers the out-of-pocket expenses for patients with serious illnesses such as cancer and rare diseases, which typically come with high medical costs. Generally, patients are responsible for 20% of inpatient and 30-60% of outpatient costs. However, if registered as a beneficiary of the special cost reduction program, patients only need to pay 0-10% for both inpatient and outpatient care. These benefits are available for five years after registering with the National Health Insurance Service.

Starting this year, 75 new diseases-including 70 newly designated rare diseases such as 'ARHGEF9-related disorders' and 5 additional diseases classified by detailed disease codes-will be eligible for benefits. As a result, the total number of rare diseases covered by the special cost reduction program has increased from 1,314 to 1,389.

The National Health Insurance Service expects that with this expansion, newly eligible patients with rare diseases who receive treatment for these diseases and related complications will only pay 10% of their medical expenses, resulting in an estimated annual reduction of approximately 1.47 billion won in household medical costs.

The number of designated diagnostic and treatment institutions eligible to register patients for the special cost reduction program will also be expanded to include those capable of handling ultra-rare diseases, undiagnosed rare diseases, and other chromosomal abnormalities, which require complex diagnostics and specialized analysis. This year, Gyeongsang National University Hospital in Jinju, Gyeongnam, and Wonkwang University Hospital in Iksan, Jeonbuk, have been newly designated as diagnostic and treatment institutions. Consequently, the total number of advanced general hospitals nationwide where patients can register for the special cost reduction program for ultra-rare diseases and similar conditions has increased to 44.

Kim Namhun, Executive Director of Benefits at the National Health Insurance Service, stated, "We will continue to expand the application of the special cost reduction program to newly diagnosed rare diseases as diagnostic technologies advance. We will also make ongoing efforts to eliminate healthcare blind spots by expanding diagnostic and treatment institutions, so that patients with rare diseases can receive early diagnosis and appropriate treatment within their local communities."