MRI and Ultrasound Health Insurance Barriers Likely to Increase... Government Holds First Meeting to Revise 'Moon Jae-in Care'

Government-Medical Sector First Meeting... Plans for Discussions by Specialized Subcommittees

MRI scan reference image. The photo is not related to the article. [Photo by Asia Economy DB]

The government and the medical community gathered for the first time to improve the coverage of magnetic resonance imaging (MRI) and ultrasound. This move aims to accelerate health insurance reform amid concerns over the deterioration of health insurance finances caused by the previous administration's policy of expanding coverage, known as the 'Moon Jae-in Care.'

On the 27th, the Ministry of Health and Welfare held the first meeting of the 'MRI and Ultrasound Coverage Criteria Improvement Council' at the Seoul International Electronics Center. The council includes health authorities such as the Ministry of Health and Welfare, the Health Insurance Review and Assessment Service, and the National Health Insurance Service, as well as medical organizations like the Korean Medical Association and the Korean Hospital Association.

According to the Ministry of Health and Welfare, MRI and ultrasound examinations have been covered by health insurance for severe diseases such as cancer since 2005, but coverage was significantly expanded to include general disease (suspected) patients in August 2017 under the health insurance coverage enhancement plan. However, despite concerns about excessive testing due to the broad coverage of previously non-covered services, substantial improvements in coverage criteria were insufficient, leading to financial leakage. In fact, medical expenses for MRI and ultrasound examinations surged from 189.1 billion KRW in 2018 to 1.8476 trillion KRW in 2021, a tenfold increase since the coverage expansion.

In response, the current administration has been reviewing ways to improve coverage criteria. For example, in the case of brain and cerebrovascular MRI related to headaches and dizziness, while coverage was previously recognized when neurological examinations were performed, a plan is being considered to recognize coverage only when abnormal findings are present in the examination and to limit the maximum number of scans from three to two. Additionally, regarding upper abdominal ultrasound, coverage for ultrasound performed for surgical risk assessment is being discussed to apply only when medically necessary.

At the first meeting, the council formed a consensus between health authorities and the medical community on the need to improve coverage criteria and discussed the council’s operation plan and review schedule, including the plan to promote coverage criteria improvement. To enhance the efficiency and expertise of future discussions, subcommittee meetings will be held by specialized fields, where related professional societies will participate to focus intensively on the medical validity of the proposed coverage criteria improvements.

The proposed coverage criteria improvements prepared through the council’s discussions will be finalized through deliberation by the Health Insurance Policy Deliberation Committee and revision of the coverage criteria notification. Kang Jun, Director of the Medical Security Innovation Division at the Ministry of Health and Welfare, stated, "We will maintain the health insurance benefits that the public appropriately uses without change, but for items where there is a need to improve coverage criteria to block financial leakage, we will discuss with the medical community to establish reasonable coverage criteria based on medical necessity."

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