Three Items, Including Manual Therapy and Percutaneous Epidural Neuroplasty, Selected as Managed Benefit Services

Fourth Meeting of the Non-Reimbursable Management Policy Council
Further Review Planned for Extracorporeal Shock Wave Therapy and Speech Therapy

Manual therapy, percutaneous epidural neuroplasty, and radiothermotherapy, which were previously non-reimbursable items under the National Health Insurance, will now be converted to managed benefits.

The Ministry of Health and Welfare announced on December 9 that this decision was made during the 4th meeting of the "Non-Reimbursable Items Management Policy Council," a discussion body for appropriate management of non-reimbursable items.

Managed benefits refer to a system in which non-reimbursable items deemed to be overused beyond medical necessity are incorporated into the National Health Insurance framework, with established clinical criteria and pricing for management purposes.

Previously, at the 3rd meeting held on November 14, the council decided to prioritize the review of manual therapy, extracorporeal shock wave therapy, percutaneous epidural neuroplasty, radiothermotherapy, and speech therapy as managed benefit items, based on trends in non-reimbursable medical expenses and service volumes, as well as recommendations from participating members.

At the 4th meeting, after thorough review of the need for management, social benefits, and required financial resources for the five items, as well as expert opinions, three items-manual therapy, percutaneous epidural neuroplasty, and radiothermotherapy-were selected as managed benefits. These three items will undergo evaluation by the Appropriateness Assessment Committee and the Expert Review Committee, after which the Health Insurance Policy Deliberation Committee, the highest decision-making body for health insurance policy, will make the final decisions on benefit criteria and pricing.

The council also decided to revisit the conversion of extracorporeal shock wave therapy and speech therapy to managed benefits at a later date.

Kwon Byungki, Director of Essential Medical Support at the Ministry of Health and Welfare, stated, "The managed benefit system is being promoted to address issues such as excessive treatment and significant price differences among certain non-reimbursable items, and to mitigate the outflow of medical personnel to non-essential medical fields where non-reimbursable coverage is more easily applied. Now that the first items have been selected, we will continue discussions to establish reasonable pricing and benefit criteria, while monitoring the effects and further developing the system."

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