Starting in January, patients in South Korea who exceed 300 outpatient visits in a year will pay 90% of the cost out of pocket from the 301st visit onward.
The Ministry of Health and Welfare said a partial amendment to the enforcement decree of the National Health Insurance Act containing the measure was approved at a Cabinet meeting on the 8th.
South Koreans made an average of 17.9 outpatient visits per person in 2024, 2.7 times the Organisation for Economic Co-operation and Development average of 6.6. Of roughly 48.4 million people who used outpatient care last year, 7,765 exceeded 300 visits. One patient recorded 1,775 outpatient visits in a single year.
To curb excessive use of medical services, the government raised the copayment rate to 90% for those exceeding 365 outpatient visits a year, effective July 2024. The threshold will tighten to 300 visits next year, equivalent to about six visits to a medical institution each week.
Children, pregnant women, and patients covered by the special copayment program — including those with severe disabilities and severe, rare or intractable illnesses — are exempt, as frequent outpatient care is unavoidable for them. Other patients may also be granted exemptions after review by the National Health Insurance Service's committee on excessive medical use.
The government will also introduce a system allowing medical institutions to check treatments and prescriptions a patient has received at other providers. The system will apply first to computed tomography (CT) and magnetic resonance imaging (MRI) scans from December 24 this year before expanding to other categories. It will be linked to hospitals' electronic medical records (EMR) to minimize administrative burdens.
Requirements for salaried health insurance enrollees to pay settlement premiums in installments will also be eased. Currently, the additional premium must be at least equal to one month's employee share of the monthly wage-based premium to qualify for installments of up to 12 payments. From October 1, enrollees can apply if the amount is at least the minimum monthly wage-based premium — or 10,080 won this year. The deadline for workplaces to report year-end premium settlement data will be extended to March 31 from March 10.
The amendment also clarifies the grounds for authorities to unilaterally revise coverage decisions, allowing reviews of medical procedures and treatment materials already designated as covered or non-covered if their safety, efficacy or cost-effectiveness changes. It further specifies in law that drugs approved or registered for marketing but not designated for health insurance coverage fall under non-covered items.
