'Strengthening Essential Medical Care' Government to Invest 300 Billion KRW Annually in Improving Delivery and Pediatric Fees

The government will invest 300 billion KRW annually to improve delivery and pediatric medical fees in order to strengthen essential healthcare.

On the 26th, the Ministry of Health and Welfare held the 21st Health Insurance Policy Deliberation Committee meeting this year and made this decision. At the meeting, the committee approved the establishment of a pediatric care policy surcharge, improvement plans for delivery fees under essential medical support measures, changes in patient co-payment rates for next-generation sequencing-based genetic panel tests following selective benefit suitability evaluation, and the determination of health insurance coverage for digital therapeutic devices and artificial intelligence (AI) innovative medical technologies. Discussions were also held on the fourth phase pilot project for health primary care physicians for the disabled (including the pilot project for dental primary care physicians for the disabled) and the extension of the upper limit surcharge period for cold medicine (AAP 650mg).

Establishment of Pediatric Care Policy Surcharge

As part of measures to normalize pediatric care, the Ministry of Health and Welfare will establish and support a policy surcharge to maintain the infrastructure of pediatric and adolescent specialists starting January next year. Approximately 30 billion KRW will be invested annually. The committee discussed support measures for the policy surcharge to maintain pediatric and adolescent care infrastructure due to difficulties such as the decrease in pediatric clinics and specialists. While the total number of clinics increased by 2,467 compared to 2019, pediatric clinics decreased by 92 last year. The pediatric resident recruitment rate also dropped from 100% in 2018 to 25.5% this year.

The target institutions are medical facilities that designate themselves as pediatric and adolescent clinics. A policy surcharge will be provided when pediatric specialists conduct initial consultations for patients under six years old. The support amount is 7,000 KRW for children under one year old and 3,500 KRW for children under six years old. Patient co-payments are expected to increase by 400 KRW (clinics) to 1,400 KRW (tertiary hospitals) for under one year old, and 700 KRW (clinics) to 1,500 KRW (tertiary hospitals) for under six years old compared to the current billing standards.

Improvement of Delivery Fees ? Introduction of Regional and Safety Policy Fees

In addition, the Ministry of Health and Welfare will invest 260 billion KRW annually from health insurance finances to significantly improve delivery fees to maintain the delivery infrastructure in local communities as part of essential medical support measures. Due to low birth rates, demand such as the number of deliveries continues to decline, and medical providers tend to avoid delivery-related care due to liability concerns over medical disputes. Accordingly, the committee prepared a plan to apply public policy fees at the regional and institutional levels. The number of deliveries at hospitals and clinics (excluding midwifery centers) decreased by 47.3% over 10 years. Medical institutions providing delivery care also decreased by 36.7% over 10 years.

The Ministry will introduce regional fees and safety policy fees considering the local conditions of delivery medical institutions and the facilities and personnel of each institution. To resolve the imbalance of medical resources according to regional conditions, medical institutions in all areas except special and metropolitan cities will be compensated 550,000 KRW per delivery. To create a safe delivery environment for preventing medical accidents, medical institutions with full-time obstetricians and delivery rooms will receive an additional 550,000 KRW per delivery as a safety policy fee.

Accordingly, the basic delivery fee will increase by 550,000 to 1,100,000 KRW per delivery, which is expected to help maintain the operation of individual medical institutions that continuously provide delivery care.

Furthermore, the high-risk delivery surcharge, applied when the mother is elderly or has complications, will be expanded from the current 30% up to a maximum of 200%, and emergency delivery policy fees (550,000 KRW) will also be supported for institutions where medical staff can be on standby in the delivery room at all times.

Tertiary hospitals and high-risk maternal and neonatal integrated care centers (20 locations) perform fewer absolute deliveries but handle more high-risk and emergency deliveries, so this measure is expected to strengthen compensation in these more challenging care areas. The improvement of delivery fees will be applied from December after revising the health insurance notification next month.

Extension of Upper Limit Surcharge Period for Acetaminophen

The Ministry of Health and Welfare decided to extend the temporary upper limit surcharge period for acetaminophen 650mg by four months, which was granted conditionally to increase production due to cold medicine supply shortages caused by the resurgence of COVID-19 and influenza outbreaks at the end of last year. This aims to respond stably to the increased demand for cold patients during the winter flu season and considers the prescription and dispensing period for mandatory production volumes. At that time, the insurance price of acetaminophen 650mg, which was 50 KRW per tablet, was raised to 70 KRW from December last year considering manufacturing and import costs, and a temporary price surcharge was applied for one year based on each pharmaceutical company's supply contribution (volume) to induce additional supply.

Next-generation sequencing genetic panel tests analyze large amounts of genetic information quickly by breaking down and recombining genetic material to decode information. Expected as a test technology for personalized treatment such as increased use of targeted therapies, it was registered in 2017 with a 50% patient co-payment rate under selective benefits. The first suitability evaluation concluded, based on expert advisory discussions, that due to significant differences in evidence accumulation levels by cancer type and the current use of targeted anticancer drugs, it is necessary to apply different patient co-payment rates by disease.

For 'progressive, metastatic, or recurrent non-small cell lung cancer (lung adenocarcinoma),' considering the generation of clinical evidence and the availability of multiple targeted anticancer drugs, the current 50% patient co-payment rate will be maintained. For 'other progressive, metastatic, or recurrent solid cancers,' 'six major hematologic cancers,' and 'hereditary diseases,' the patient co-payment rate will be raised from 50% to 80%, but if evidence of treatment effectiveness is confirmed through clinical research, the co-payment rate will be lowered. The 'early cancer and other special calculation cancers,' which previously had a 90% co-payment rate, will maintain the current rate.

Health Insurance Coverage Decision for Digital Therapeutic Devices and AI Innovative Medical Technologies

This applies to new medical technology fields such as digital therapeutic devices and AI imaging diagnostic medical devices. According to guidelines established in August, innovative medical technologies (selective benefits with a 90% patient co-payment rate) in the AI field will receive separate fees ranging from 310 to 2,920 KRW. The usage fee for digital therapeutic devices will be determined based on cost and set per product.

The 'Health Primary Care Physician Pilot Project for the Disabled' will be improved and the fourth phase pilot project will be implemented from February next year. The target population will be expanded from severe disabilities to all disabled persons. To strengthen home visit services for people with severe disabilities, the visit fee will be increased (clinic level, from 126,900 KRW to 189,010 KRW) and the maximum number of visits will be expanded (from 18 to 24 times annually). The pilot project for dental primary care physicians will be expanded nationwide, expected to contribute to guaranteeing the health rights and medical accessibility of disabled persons.

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