'Health Insurance Medical Fees' to Increase by 1.98% Next Year ... Additional 1.0848 Trillion Won Required for Budget

Negotiations Fail with Two Organizations Including Medical and Korean Medicine Groups... Final Decision at Health Insurance Policy Committee on the 2nd
From Next Year, Patient Copayment for Hospital and Dental Treatments to Increase by 100 Won

On the 17th, when 621,328 new COVID-19 cases were reported, visitors at a clinic in Seoul were waiting to take rapid antigen tests. Photo by Jinhyung Kang aymsdream@

[Asia Economy Reporter Jo In-kyung] The 'fee' paid by health insurance to healthcare institutions such as hospitals, dental clinics, and pharmacies that provide medical services will increase by an average of 1.98% next year.

The National Health Insurance Service (NHIS) announced on the 1st that it has concluded negotiations for the 2023 medical fee schedule contract with five medical organizations: the Korean Hospital Association, the Korean Dental Association, the Korean Pharmaceutical Association, the Korean Nurses Association, and the Korean Midwives Association. The fee negotiations were completed that morning and were subsequently reviewed and approved by the Financial Management Committee.

The average fee increase rate for next year was set at 1.98%, which is 0.11 percentage points lower than this year's increase rate of 2.09%. The additional financial requirement resulting from this is estimated at 1.0848 trillion KRW.

The increase rates by institution are as follows: hospitals 1.6%, dental clinics 2.5%, pharmacies 3.6%, midwifery centers 4.0%, and health institutions 2.8%. Accordingly, from next year, the patient's burden will increase by 100 KRW at hospitals or dental clinics, and by 240 KRW at pharmacies.

For hospitals, the fee for the first outpatient visit covered by health insurance (outpatient initial consultation fee) will increase from 16,370 KRW this year to 16,650 KRW next year, a rise of 280 KRW. Consequently, the patient's out-of-pocket payment will increase from 6,500 KRW to 6,600 KRW, a 100 KRW increase.

Similarly, the outpatient initial consultation fee at dental clinics will rise from 15,110 KRW to 15,490 KRW, an increase of 380 KRW, and the patient's out-of-pocket payment will increase from 4,500 KRW to 4,600 KRW, a 100 KRW increase. For pharmacies, the dispensing fee for a 3-day prescription will increase from 6,260 KRW to 6,500 KRW, a 240 KRW increase.

However, in this negotiation, two organizations?the Korean Medical Association and the Korean Oriental Medicine Association?did not accept the fee increase proposal presented by the NHIS, resulting in a final breakdown of negotiations for clinics and Oriental medicine types.

This year's negotiations were expected to have many variables and significant differences in perspectives between subscribers and providers, as issues related to COVID-19, such as prolonged pandemic effects, compensation for losses, and vaccination costs, emerged as core topics. Since early this year, the NHIS held several meetings among heads of medical organizations to coordinate opinions between subscriber groups and provider groups. Unusually, a representative of the providers' negotiation team also appealed to the Financial Committee about the difficulties faced by the medical community during a subcommittee on finances.

Lee Sang-il, the NHIS negotiation team leader and Executive Director of Benefits, expressed, "We appreciate the medical community's dedication in overcoming the national disaster situation caused by COVID-19," but added, "Amid economic and social uncertainties and concerns about additional financial and premium increase burdens, the NHIS made every effort to find a reasonable balance."

The NHIS plans to report the results of the 2023 medical fee schedule contract, which were reviewed and approved by the Financial Management Committee, to the Health Insurance Policy Deliberation Committee (HIPDC) meeting scheduled for the 2nd. The HIPDC will decide on the conversion factors for clinics and Oriental medicine types, where negotiations broke down, in accordance with the National Health Insurance Act within this month. Subsequently, the Minister of Health and Welfare will finalize and announce the 2023 health insurance medical fee schedule.

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