From July, patients receiving outpatient care over 365 times a year will have a 90% co-payment rate

Starting from July, if outpatient visits exceed 365 times annually, the patient’s co-payment rate will be increased to 90%.

According to the Ministry of Health and Welfare on the 27th, the "National Health Insurance Act Enforcement Decree Amendment" with this content will be enforced from July 1.

According to the amendment, patients who exceed 365 outpatient visits per year must bear 90% of the total medical care benefit costs for the excess outpatient visits. The Ministry of Health and Welfare explained that this measure aims to encourage rational use of medical services and prevent waste of medical resources caused by unnecessary medical use. However, children under 18, pregnant women, persons with disabilities, patients with rare and intractable diseases, and patients with severe illnesses who require more than 365 outpatient visits annually are exempt from this rule.

After applying health insurance, the usual outpatient co-payment rate is around 20%. However, if the patient has private indemnity insurance, the actual co-payment rate can be reduced to 0?4%. Because of this, the health insurance authorities believe that some patients excessively use medical services beyond what is necessary.

The Ministry of Health and Welfare also plans to introduce a service that informs health insurance subscribers quarterly about their cumulative outpatient visits, hospitalization days, health insurance benefit costs, and co-payment amounts through KakaoTalk, Naver, and the "The Geongangboheom" app.

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