Emergency Room Consultation Fee and Severe Surgery Additional Charges Extended for One More Month... Health Insurance Coverage Applied to COVID-19 Treatments

Health Insurance Policy Committee Reviews and Approves Improvement Measures for Benefit Standards
Reduces Patient Copayment Rate to 15% for Severe Home Medical Visit Care

The government has decided to extend the additional fees for emergency room specialist consultations and severe/emergency surgeries for the time being to prevent gaps in medical care for emergency and severe patients during the recent Chuseok holiday. Additionally, starting next month, health insurance will cover COVID-19 treatments, keeping patient co-payments at around 50,000 won.

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On the 26th, the Ministry of Health and Welfare held the '19th Health Insurance Policy Deliberation Committee Meeting of 2024' and resolved to extend the 'Emergency Medical Care System Health Insurance Support Plan' worth 208.5 billion won per month to prevent gaps in medical care for emergency and severe patients and minimize patient inconvenience amid the prolonged emergency medical situation caused by ongoing physician collective actions.

Accordingly, the temporary additional fees for mild patient transfer fees, enhanced compensation for emergency patients and severe inpatients will be extended. Furthermore, the additional fees for emergency medical center specialist consultation fees (150-250% increase) and severe/emergency surgeries (200% increase), which were temporarily raised for nine months to maintain the emergency medical system, will be extended for about one more month until November 10.

A Ministry of Health and Welfare official stated, "We will support the temporary emergency medical fees to ensure no gaps occur in emergency and severe patient care, and we will make further efforts to resolve the emergency situation promptly so that the public does not face difficulties in accessing medical institutions."

At the same meeting, it was also decided to apply health insurance coverage from next month for the COVID-19 treatments 'Paxlovid tablets' and 'Veklury,' which had been purchased and supplied by the Korea Disease Control and Prevention Agency. Along with insurance listing, related legal amendments will be pursued to maintain patient co-payments at the current level of 50,000 won and to support stable supply of the treatments.

Starting next month, the coverage scope for treatments of patients with advanced ovarian cancer, fallopian tube cancer, and primary peritoneal cancer (active ingredient: niraparib tosylate monohydrate) will be expanded and the maximum price lowered, allowing health insurance coverage. Previously, coverage was only applied if the genetic test was positive for BRCA mutations related to ovarian cancer, but going forward, coverage will be extended to all homologous recombination deficiency positive gene mutations, including cases with genomic instability related to ovarian cancer. As a result, the annual medication cost burden of about 41 million won for advanced ovarian cancer patients is expected to decrease to approximately 2.05 million won (with a 5% patient co-payment).

Discussions were also held on improving the 'Primary Care Home Visit Medical Service (Medical)' pilot project aimed at enhancing medical accessibility for severely ill patients with mobility difficulties living at home. To promote health insurance-covered home visits, the number of participating institutions will be expanded to allow hospitals designated as home care centers (regional medical centers) to provide home visit services, and the patient co-payment for severely ill home care patients with high home care needs will be reduced from the current 30% to 15%.

From November, the 'Supraglottic Airway Device,' a selective benefit item used when endotracheal intubation is difficult during standard procedures such as cardiopulmonary resuscitation, will be converted to an essential benefit when used in emergency situations, and the patient co-payment rate will be reduced from the current 50% to between 5% and 20%.

Additionally, the 'NK Cell Activity Test,' which measures cellular immune activation to monitor treatment progress for stomach or prostate cancer patients, will have its coverage discontinued and be converted to non-covered status based on expert opinions indicating unclear medical validity, following a suitability evaluation.

The Ministry of Health and Welfare stated, "This decision respects the common judgment by related academic societies that the medical validity is unclear. Since the total usage has dropped by nearly 80% after the initial suitability evaluation in clinical settings, it is necessary for doctors and patients to carefully discuss the usefulness and utilization plans of the test to determine whether to use it."

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