Ultrasound for Eye Covered by Health Insurance... Less Than Half the Cost Burden

[Asia Economy Reporter Cho Hyun-ui] Starting this September, the cost of eye examinations such as ultrasound for suspected eye diseases or preoperative tests for cataract and glaucoma surgeries will be reduced to less than half.

On the 24th, the Ministry of Health and Welfare held the 13th Health Insurance Policy Deliberation Committee meeting and reported on the application of health insurance coverage for ophthalmic disease tests, including eye ultrasound for 2- and 3-person rooms in hospitals and Korean medicine hospitals.

Accordingly, the scope of health insurance coverage will be fully expanded for ultrasound-based ▲ocular and orbital examinations ▲biometric tests to determine the power of intraocular lenses to be implanted during cataract surgery ▲ultrasound pachymetry to measure corneal thickness for glaucoma diagnosis and treatment.

These tests are essential for diagnosing retinal diseases or glaucoma, deciding treatment methods, or performing cataract surgery, but until now, insurance coverage was only applied to patients with the four major severe diseases. Other patients had to bear the full cost of the tests, and prices varied by medical institution, resulting in a heavy burden.

However, from September 1, with the significant expansion of health insurance coverage, patients with ocular or orbital diseases or suspected diseases can receive health insurance coverage once for ocular and orbital ultrasound examinations.

High-risk patients are allowed one additional test, and for those requiring follow-up observation, health insurance will be applied with an 80% co-payment rate. Biometric tests performed during cataract surgery will also be covered once by health insurance, with one additional test recognized if medically necessary.

This expansion of health insurance coverage is expected to greatly reduce the medical expenses related to eye ultrasound examinations. The average non-reimbursed customary price for ocular and orbital examinations ranged from 92,000 KRW to 128,000 KRW depending on the type of medical institution, but the patient’s out-of-pocket cost will be reduced to 22,700 KRW (clinics) to 45,500 KRW (tertiary general hospitals) for outpatient care.

For biometric ultrasound tests before cataract surgery, which frequently occur in the elderly, the average non-reimbursed customary price ranged from 75,000 KRW to 123,000 KRW depending on the medical institution. With insurance coverage, outpatient costs will decrease to 20,700 KRW (clinics) to 41,600 KRW (tertiary general hospitals).

The average non-reimbursed customary price for biometric laser tests was about 96,000 KRW, but the patient’s out-of-pocket cost will be lowered to 25,600 KRW (clinics) to 51,500 KRW (tertiary general hospitals) for outpatient care.

Additionally, health insurance will be applied to indocyanine green fundus angiography, fluorescein anterior segment angiography, and artificial ocular body treatment materials used for ophthalmic diseases, significantly easing the burden on patients.

It is expected that approximately 1 to 1.5 million people annually will benefit from the reduced examination costs.

The Ministry of Health and Welfare is also promoting the inclusion of rheumatoid arthritis and hematopoietic blood tests in insurance coverage. As a result, medical expenses are expected to decrease to between one-sixth and one-thirty-fifth of the current costs.

First, health insurance will cover the anti-CCP antibody test for early diagnosis of rheumatoid arthritis and three types of hematopoietic disease tests. The test fees will sharply drop from the previous non-reimbursed 46,000 KRW to around 7,000 KRW for outpatient care after insurance coverage. The cost of three tests for diagnosing rare hematopoietic-related diseases will also be reduced by up to 100,000 KRW.

A pilot project for health insurance coverage of herbal decoctions (Cheopyak) will also be implemented. Cheopyak, a personalized herbal medicine, has a high out-of-pocket cost but the market size is steadily increasing. Among Korean medicine treatments, the demand for health insurance coverage for Cheopyak is the highest.

Accordingly, aiming for implementation in October, outpatient health insurance subscribers who receive Cheopyak prescriptions at participating Korean medicine clinics for facial nerve palsy, sequelae of cerebrovascular disease (aged 65 and older), and dysmenorrhea will be eligible for pilot fees. Including consultation fees, the total cost will be about 108,760 KRW to 150,880 KRW (based on 20 doses over 10 days), with a 50% co-payment rate applied for up to 10 days per patient annually. This will allow patients to take therapeutic Cheopyak at a cost of 51,700 KRW to 72,700 KRW.

At the Health Insurance Policy Deliberation Committee, reports were also received on new drug listings, expansion of insurance coverage criteria, and the results of re-evaluation of drug insurance appropriateness.

This content was produced with the assistance of AI translation services.