{"content_id":"l222gxysdv","slug":"korea-health-insurance-fee-reform-essential-care-2026","locale":"en","schema_type":"Report","category":"report","category_name":"Report","title":"Reform of the Health Insurance Fee Schedule: Shifting from a Test-Centric Approach to a Focus on Regional and Essential Healthcare","summary":"The government finalized its plan to reform the health insurance fee structure in June 2026 and decided to reduce the test-centric reimbursement structure to reallocate funds toward regional and essential medical care. The key is to adjust over-reimbursed items such as laboratory tests, CT scans, and MRIs, and to invest 3.6 trillion won annually in essential areas such as outpatient care, hospitalization, emergency care, childbirth, and pediatric care.","key_points":["The government has decided to adjust the national health insurance fee schedule on the largest scale since the introduction of the relative value score system in 2001.","By reducing excessive spending on laboratory tests, CT scans, MRIs, and other diagnostic procedures, we will save 2.6 trillion won annually and allocate an additional 1 trillion won from the National Health Insurance Fund to regional and essential healthcare.","Initial visits at clinics are set to increase by 6%, follow-up visits by 4%, general ward hospitalization fees by 7%, and intensive care unit (ICU) hospitalization fees by 10%.","Regional preferential fee schedules will be applied in non-metropolitan areas and underserved areas within the Seoul metropolitan area, thereby strengthening reimbursement for surgeries and medical procedures, emergency surgeries, high-risk deliveries, and pediatric intensive care.","Although out-of-pocket costs for patients may vary depending on the type of treatment and the copayment rate, the government maintains that the system is designed to ensure that total out-of-pocket medical expenses do not increase."],"content_markdown":"## Reform Details at a Glance\n\nOn June 25, 2026, the government finalized the **Health Insurance Fee Structure Reform Plan** at a meeting of the Health Insurance Policy Deliberation Committee. This reform is described as the largest-scale fee adjustment since the introduction of the Health Insurance Relative Value Score system in 2001.\n\nThe core objective is simple: **to reduce the structure where revenue increases with the number of tests performed, and to provide greater compensation for medical services essential to maintaining the healthcare system, such as emergency care, childbirth, pediatrics, inpatient care, and general consultations**.\n\n| Category | Existing Issues | Reform Direction |\n|---|---:|---|\n| Laboratory Tests, CT, MRI | Criticism that high returns relative to costs create an incentive for excessive testing | Gradual adjustment of fees for overcompensated items |\n| Consultations·Hospitalization | Criticism that medical staff’s time and patient explanations are not sufficiently compensated | Increase base reimbursement rates for consultation and hospitalization fees |\n| Regional Healthcare | Difficulty maintaining essential care at hospitals in non-metropolitan and underserved areas | Apply preferential regional reimbursement rates |\n| Emergency and Critical Care | Insufficient compensation for on-call duty during nights and holidays and for high-complexity treatments | Strengthen compensation for emergency surgeries, critical surgeries, and anesthesia |\n| Obstetrics and Pediatrics | Weakening infrastructure for high-risk deliveries, neonatal intensive care, and critical pediatric care | Expand separate compensation for maternal and child health and pediatrics |\n\n## What Are Health Insurance Reimbursement Rates?\n\n**Health insurance reimbursement rates** are the price list for medical procedures covered by health insurance. When patients receive treatment at a hospital, the amount they pay at the front desk is only a portion of the total reimbursement rate; the National Health Insurance Service covers the remainder.\n\nHealth insurance reimbursement rates are typically calculated using the following structure.\n\n- **Relative Value Score**: A score reflecting the workload, treatment costs, and risk level associated with each medical procedure\n- **Conversion Index**: The unit price per score\n- **Adjustments (Increases or Decreases)**: Adjustments applied based on region, night/holiday hours, severity of illness, and the functions of the medical institution\n\nIn other words, fee schedule reform is not merely a policy that changes hospital revenue. It is a policy that simultaneously alters how medical institutions allocate personnel and equipment to specific treatments, the extent to which patients can access care, and how health insurance funds are spent.\n\n## Why Is This Considered the First Major Reform in 25 Years?\n\nThe relative value score—the core of the current health insurance fee-for-service system—was introduced in 2001. At that time, high-cost equipment such as CT and MRI scanners was less widespread than it is today, and it was relatively straightforward to establish a reimbursement system for tests where costs were easy to calculate, such as equipment prices or reagent costs.\n\nConversely, it was difficult to calculate the cost of consultation fees. This is because the time a doctor spends with a patient, the quality of explanations provided, and the difficulty of comprehensively assessing complex conditions are hard to quantify simply with numbers. As a result, criticism grew over time that while high reimbursement rates were maintained for equipment-based tests, basic and essential medical services—such as consultations, hospitalizations, anesthesia, and emergency treatment—were relatively undervalued.\n\nAccording to an analysis released by the government, an examination of approximately 6,000 medical health insurance fee codes revealed that laboratory tests, such as blood tests, yielded a return on cost of about 190%, while specialized imaging tests, such as CT and MRI scans, yielded a return of about 194%. In contrast, services such as consultations, hospitalizations, and anesthesia were classified as under-reimbursed areas.\n\n## Financial Structure: 2.6 Trillion Won in Savings + 1 Trillion Won in Additional Funding\n\nThe financial structure of this reform is broadly divided into two parts.\n\n| Funding Source or Expenditure Item | Scale | Description |\n|---|---:|---|\n| Adjustment of excessive spending on laboratory tests, CT, MRI, etc. | Annual savings of 2.6 trillion won | Securing fiscal capacity by reducing the test-centric reimbursement structure |\n| Additional Funding for Health Insurance | 1 trillion won annually | Additional funds to expand reimbursement for essential medical care |\n| Expansion of Reimbursement for Regional and Essential Medical Care | 3.6 trillion won annually | Allocated to outpatient visits, hospitalization, emergency care, childbirth, pediatrics, and post-acute care |\n\nThe government has proposed a strategy that, rather than simply cutting reimbursement rates for laboratory tests, CT scans, and MRIs across the board, will adjust overcompensated items where the return on cost exceeds a certain threshold and link these adjustments to quality control measures for medical tests.\n\n## What Will Increase and What Will Decrease\n\n### 1. Consultation Fees Will Increase\n\nConsultation fees at clinics are scheduled to be adjusted as follows.\n\n| Item | Increase Rate | Before Adjustment | After Adjustment |\n|---|---:|---:|---:|\n| Initial Consultation Fee at Clinic Level | 6% | 18,840 won | 19,980 won |\n| Follow-up Consultation Fee at Clinics | 4% | 13,370 won | 13,900 won |\n| Initial and Follow-up Consultations at Hospitals and Above | 2% | Varies by institution | Varies by institution |\n\nThe **in-depth consultations lasting 15 minutes or longer**, which had been piloted at tertiary general hospitals, will be transitioned into a full-scale program, and the number of applicable sessions will be expanded. In-depth consultations at general hospitals and in-depth primary care consultations lasting 10 minutes or longer in certain medical departments will also be introduced.\n\nThe significance of this change is that the system will provide greater reimbursement for “care that involves listening carefully and providing thorough explanations” rather than “care that consists of brief consultations and numerous tests.”\n\n### 2. Hospitalization Fees Will Increase\n\nReimbursement for hospitalization services will also be strengthened.\n\n| Item | Increase Rate | Meaning |\n|---|---:|---|\n| Basic Inpatient Fee for General Wards | 7% | Expansion of basic reimbursement for inpatient care on general wards |\n| Basic Inpatient Fee for Intensive Care Units (ICUs) | 10% | Expansion of reimbursement for critical care requiring intensive staffing and equipment |\n\nThe hospitalization fee system will also be revised so that wards requiring more nursing staff receive higher reimbursement. This aims to encourage hospitals to secure more staff for managing inpatients.\n\n### 3. Regional Preferential Rates Will Be Introduced\n\nRegional preferential fee rates will be applied in principle to non-metropolitan areas and certain underserved areas within the Seoul metropolitan area. Additional reimbursement will be provided for surgeries, procedures, and emergency care in non-metropolitan areas, as well as in the Uijeongbu, Namyangju, Icheon, and Pocheon regions of Gyeonggi Province, and the Northwest and Central regions of Incheon.\n\nThe key details are as follows:\n\n- A 10% surcharge on approximately 2,700 surgeries and procedures at general hospitals and higher-level medical institutions\n- An additional 10% surcharge for emergency surgeries and procedures performed at night or on holidays\n- Regional preferential fee schedules of up to 20% will be applied in certain areas\n- A 5% surcharge on consultation fees for medical institutions in 84 cities, counties, and districts experiencing population decline\n- An additional 5% payment on hospitalization fees for general hospitals and hospitals in these areas\n\nThe purpose of this system is to reflect the costs and challenges involved in maintaining essential medical care in these regions, even for the same medical procedures.\n\n### 4. Compensation for Critical and Emergency Final Treatment Will Increase\n\nThe government will invest 900 billion won annually in critical and emergency final treatment. The plan includes a 20% increase in reimbursement rates for approximately 1,600 of the roughly 2,700 surgeries and procedures performed at general hospitals and higher-level facilities, as well as compensation of up to 5.5 times the standard rate for emergency surgeries performed at night or on holidays.\n\nReimbursement rates for general anesthesia will also increase by 50% from current levels. This signifies a commitment to compensating not only for the surgery itself but also for the anesthesia, preoperative preparation, and emergency response capabilities that make the surgery possible.\n\n### 5. Compensation for Childbirth and Pediatric Care Will Be Strengthened\n\nFrom the perspective of medical institutions, childbirth and pediatric care involve high staffing burdens and risks, yet demand varies significantly by region, making these fields prone to reduced supply. This reform allocates separate funding to these areas.\n\n| Field | Funding Allocation | Key Details |\n|---|---:|---|\n| High-Risk Pregnant Women and Newborns | 100 billion won annually | Enhanced compensation for high-risk deliveries, neonatal intensive care units, and maternal and child health centers |\n| Pediatric Care | 200 billion won annually | Expansion of the age range for pediatric consultation surcharges; introduction of surcharges for complex pediatric surgeries; enhanced compensation for pediatric intensive care units |\n\nFor example, for the delivery of a preterm infant born before 28 weeks, a surcharge of approximately 4.4 million won may apply at a specialized maternal and child health center, while at maternal and child health centers outside the Seoul metropolitan area, a surcharge of approximately 5.06 million won may apply, reflecting regional preferential rates. The age range for pediatric consultation surcharges will be expanded from under 6 years old to under 8 years old.\n\n## How Will CT, MRI, and Laboratory Tests Change?\n\nThe government is adjusting reimbursement rates for laboratory tests, CT scans, and MRI scans to reduce excessive spending in the diagnostic testing sector.\n\n| Item | Adjustment Direction | Expected Fiscal Impact |\n|---|---|---:|\n| Laboratory tests (blood, urine, etc.) | Adjustment of fees for overcompensation exceeding 150% | Annual savings of 1.7 trillion won |\n| Outsourced testing management fees | Abolition of the system and restructuring of the reimbursement framework | Annual savings of 200 billion won |\n| CT and MRI | Adjustment of items with revenue exceeding 150% of costs | Annual savings of 700 billion won |\n| Total | Adjustment of excessive spending in testing areas | Annual savings of 2.6 trillion won |\n\nHowever, this does not mean that all CT and MRI scans and all tests will be uniformly reduced. The government stated that it will pursue detailed adjustments to ensure that essential tests required for critically ill or emergency patients, as well as tests with a low risk of overtesting, can maintain their current levels.\n\n## The System for Outsourcing Laboratory Tests Is Also Changing\n\nThe system for outsourcing laboratory tests has remained largely unchanged since 1999. Under this structure, outsourcing entities—such as neighborhood clinics—request blood and urine tests, and contracted laboratories perform the actual testing.\n\nThe government believes that under the existing system, the combination of overcompensated test items and a discount structure for test fees created incentives for unnecessary testing. Accordingly, it has decided to abolish the outsourcing management fee and instead clearly divide the roles of the outsourcing and contracting institutions within the test fee structure.\n\nIn the first phase of the reform, the adjusted test fees will be allocated at a ratio of 35% to the referring institution and 65% to the testing facility. Subsequently, a system involving conditional reimbursement based on evaluations of test quality, patient safety, support for testing in underserved areas, prompt notification of critical results, and specimen tracking and management is under consideration.\n\n## How Will Patient Out-of-Pocket Costs Change?\n\nFrom the patient’s perspective, the most important question is, “If the fee schedule increases, will my out-of-pocket medical expenses also rise?” The answer is **it depends on the specific medical service and the patient’s copayment rate**.\n\nHealth insurance fees include both the portion covered by the National Health Insurance Service and the patient’s out-of-pocket copayment. Therefore, if the fee for a service subject to patient copayment increases, the patient’s out-of-pocket costs may also rise slightly. For example, since the statutory copayment rate applies to consultation fees and some hospitalization fees, the actual cost to the patient may change slightly.\n\nConversely, for services where fees are reduced—such as CT and MRI scans or laboratory tests—the patient’s out-of-pocket costs may decrease. Additionally, the government explained that for a significant number of items covered by the expanded essential medical care compensation—such as regionally preferential rates, childbirth, and hospitalization fees for children under 2 years of age—patient out-of-pocket costs will either be eliminated or kept low.\n\nTo summarize:\n\n| Potential Impact on Patients | Explanation |\n|---|---|\n| Possible partial increase in consultation and hospitalization fees | For items subject to copayment rates, part of the fee increase may be reflected in the patient’s out-of-pocket costs |\n| Possible partial decrease in testing fees | For items where fees for laboratory tests, CT scans, and MRIs are reduced, out-of-pocket costs may also decrease |\n| Some essential medical services are designed with no out-of-pocket costs for patients | For regionally preferential rates and certain childbirth, pediatric, and critical care services, out-of-pocket costs may be eliminated or kept low |\n| The final out-of-pocket cost varies by medical service | It depends on the type of medical institution, special billing exceptions, out-of-pocket cost reduction programs, and coverage criteria |\n\n## What Does This Mean for Healthcare Facilities?\n\nThis reform is a policy that changes the revenue structure of healthcare facilities. Revenue models that relied on the turnover rate of diagnostic equipment will decline, while facilities that maintain outpatient care, inpatient care, emergency care, childbirth services, pediatric care, and essential regional medical services will receive additional compensation.\n\nIn particular, hospitals outside the Seoul metropolitan area may have a greater incentive to maintain essential care through regionally preferential fee schedules. However, the actual effectiveness must be evaluated in conjunction with factors such as securing medical personnel, bed management, the emergency medical delivery system, resident training environments, and regional demographic structures. It is difficult to assume that regional essential healthcare issues will be fully resolved by fee schedules alone.\n\n## Policy Implications of This Reform\n\nThe core of this fee-for-service reform is not to “spend more” on the National Health Insurance budget, but to “spend it differently.” It reduces the relatively high-reimbursement structure centered on diagnostic tests and shifts funds to essential areas where public access would deteriorate significantly if the healthcare system were to collapse.\n\nFrom a policy perspective, this has the following implications:\n\n1. **Reform to Reduce Reimbursement Distortions**: Adjusting high-reimbursement, cost-intensive diagnostic testing areas while increasing reimbursement for under-reimbursed essential care.\n2. **Reform Reflecting Regional Disparities**: Granting additional reimbursement for essential care provided in underserved areas, even for the same medical procedures.\n3. **Reform to Enhance the Value of Consultations**: The system will shift toward rewarding thorough consultations and explanations rather than brief visits.\n4. **Improving the Efficiency of Health Insurance Finances**: Incentives for unnecessary tests will be reduced, and funds will be allocated to high-priority areas such as severe cases, emergencies, childbirth, and pediatrics.\n5. **Transition to a Continuous Adjustment System**: The current relative value revision cycle, which runs every 5 to 7 years, will be shortened to an adjustment system occurring within two years to more quickly reflect changes in medical technology and costs.\n\n## Key Issues to Monitor Going Forward\n\nThis announcement establishes the broad direction, and the actual impact on healthcare settings and patient out-of-pocket costs will be further clarified through detailed regulations and the implementation process. In particular, the following issues require ongoing monitoring:\n\n- Will the adjustment of CT and MRI fees reduce access to these necessary tests?\n- Will the increase in consultation fees lead to an actual increase in consultation time?\n- Are regional preferential fees sufficient to secure essential medical personnel outside the Seoul metropolitan area?\n- Will enhanced compensation for obstetrics and pediatrics actually improve the sustainability of hospital operations?\n- Does the reform of the diagnostic testing outsourcing system improve test quality and patient safety?\n- How will patient copayments change for each service item?\n\n## Summary\n\nThe government’s reform of the National Health Insurance fee-for-service system is a policy aimed at reducing the test-centric reimbursement structure and reallocating funds toward regional and essential healthcare. It aims to save 2.6 trillion won annually from laboratory tests, CT scans, and MRIs, and, by adding 1 trillion won from the National Health Insurance budget, invest a total of 3.6 trillion won annually in outpatient care, hospitalization, emergency care, obstetrics, pediatrics, and post-acute care.\n\nPatients may experience different effects depending on the specific medical services they receive. While consultation fees and some hospitalization fees may rise slightly, the financial burden may decrease for services where testing fees are reduced. Although the government maintains that the reform is designed to prevent an overall increase in out-of-pocket costs, the actual impact will vary depending on the detailed implementation guidelines and each individual’s specific treatment.","content_html":"\u003ch2\u003e\u003ca href=\"#reform-details-at-a-glance\" class=\"anchor\" id=\"reform-details-at-a-glance\"\u003e\u003c/a\u003eReform Details at a Glance\u003c/h2\u003e\n\u003cp\u003eOn June 25, 2026, the government finalized the \u003cstrong\u003eHealth Insurance Fee Structure Reform Plan\u003c/strong\u003e at a meeting of the Health Insurance Policy Deliberation Committee. This reform is described as the largest-scale fee adjustment since the introduction of the Health Insurance Relative Value Score system in 2001.\u003c/p\u003e\n\u003cp\u003eThe core objective is simple: \u003cstrong\u003eto reduce the structure where revenue increases with the number of tests performed, and to provide greater compensation for medical services essential to maintaining the healthcare system, such as emergency care, childbirth, pediatrics, inpatient care, and general consultations\u003c/strong\u003e.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eCategory\u003c/th\u003e\n\u003cth\u003eExisting Issues\u003c/th\u003e\n\u003cth\u003eReform Direction\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eLaboratory Tests, CT, MRI\u003c/td\u003e\n\u003ctd\u003eCriticism that high returns relative to costs create an incentive for excessive testing\u003c/td\u003e\n\u003ctd\u003eGradual adjustment of fees for overcompensated items\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eConsultations·Hospitalization\u003c/td\u003e\n\u003ctd\u003eCriticism that medical staff’s time and patient explanations are not sufficiently compensated\u003c/td\u003e\n\u003ctd\u003eIncrease base reimbursement rates for consultation and hospitalization fees\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eRegional Healthcare\u003c/td\u003e\n\u003ctd\u003eDifficulty maintaining essential care at hospitals in non-metropolitan and underserved areas\u003c/td\u003e\n\u003ctd\u003eApply preferential regional reimbursement rates\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eEmergency and Critical Care\u003c/td\u003e\n\u003ctd\u003eInsufficient compensation for on-call duty during nights and holidays and for high-complexity treatments\u003c/td\u003e\n\u003ctd\u003eStrengthen compensation for emergency surgeries, critical surgeries, and anesthesia\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eObstetrics and Pediatrics\u003c/td\u003e\n\u003ctd\u003eWeakening infrastructure for high-risk deliveries, neonatal intensive care, and critical pediatric care\u003c/td\u003e\n\u003ctd\u003eExpand separate compensation for maternal and child health and pediatrics\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003ch2\u003e\u003ca href=\"#what-are-health-insurance-reimbursement-rates\" class=\"anchor\" id=\"what-are-health-insurance-reimbursement-rates\"\u003e\u003c/a\u003eWhat Are Health Insurance Reimbursement Rates?\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eHealth insurance reimbursement rates\u003c/strong\u003e are the price list for medical procedures covered by health insurance. When patients receive treatment at a hospital, the amount they pay at the front desk is only a portion of the total reimbursement rate; the National Health Insurance Service covers the remainder.\u003c/p\u003e\n\u003cp\u003eHealth insurance reimbursement rates are typically calculated using the following structure.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eRelative Value Score\u003c/strong\u003e: A score reflecting the workload, treatment costs, and risk level associated with each medical procedure\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eConversion Index\u003c/strong\u003e: The unit price per score\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAdjustments (Increases or Decreases)\u003c/strong\u003e: Adjustments applied based on region, night/holiday hours, severity of illness, and the functions of the medical institution\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIn other words, fee schedule reform is not merely a policy that changes hospital revenue. It is a policy that simultaneously alters how medical institutions allocate personnel and equipment to specific treatments, the extent to which patients can access care, and how health insurance funds are spent.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#why-is-this-considered-the-first-major-reform-in-25-years\" class=\"anchor\" id=\"why-is-this-considered-the-first-major-reform-in-25-years\"\u003e\u003c/a\u003eWhy Is This Considered the First Major Reform in 25 Years?\u003c/h2\u003e\n\u003cp\u003eThe relative value score—the core of the current health insurance fee-for-service system—was introduced in 2001. At that time, high-cost equipment such as CT and MRI scanners was less widespread than it is today, and it was relatively straightforward to establish a reimbursement system for tests where costs were easy to calculate, such as equipment prices or reagent costs.\u003c/p\u003e\n\u003cp\u003eConversely, it was difficult to calculate the cost of consultation fees. This is because the time a doctor spends with a patient, the quality of explanations provided, and the difficulty of comprehensively assessing complex conditions are hard to quantify simply with numbers. As a result, criticism grew over time that while high reimbursement rates were maintained for equipment-based tests, basic and essential medical services—such as consultations, hospitalizations, anesthesia, and emergency treatment—were relatively undervalued.\u003c/p\u003e\n\u003cp\u003eAccording to an analysis released by the government, an examination of approximately 6,000 medical health insurance fee codes revealed that laboratory tests, such as blood tests, yielded a return on cost of about 190%, while specialized imaging tests, such as CT and MRI scans, yielded a return of about 194%. In contrast, services such as consultations, hospitalizations, and anesthesia were classified as under-reimbursed areas.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#financial-structure-26-trillion-won-in-savings--1-trillion-won-in-additional-funding\" class=\"anchor\" id=\"financial-structure-26-trillion-won-in-savings--1-trillion-won-in-additional-funding\"\u003e\u003c/a\u003eFinancial Structure: 2.6 Trillion Won in Savings + 1 Trillion Won in Additional Funding\u003c/h2\u003e\n\u003cp\u003eThe financial structure of this reform is broadly divided into two parts.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eFunding Source or Expenditure Item\u003c/th\u003e\n\u003cth\u003eScale\u003c/th\u003e\n\u003cth\u003eDescription\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eAdjustment of excessive spending on laboratory tests, CT, MRI, etc.\u003c/td\u003e\n\u003ctd\u003eAnnual savings of 2.6 trillion won\u003c/td\u003e\n\u003ctd\u003eSecuring fiscal capacity by reducing the test-centric reimbursement structure\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eAdditional Funding for Health Insurance\u003c/td\u003e\n\u003ctd\u003e1 trillion won annually\u003c/td\u003e\n\u003ctd\u003eAdditional funds to expand reimbursement for essential medical care\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eExpansion of Reimbursement for Regional and Essential Medical Care\u003c/td\u003e\n\u003ctd\u003e3.6 trillion won annually\u003c/td\u003e\n\u003ctd\u003eAllocated to outpatient visits, hospitalization, emergency care, childbirth, pediatrics, and post-acute care\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe government has proposed a strategy that, rather than simply cutting reimbursement rates for laboratory tests, CT scans, and MRIs across the board, will adjust overcompensated items where the return on cost exceeds a certain threshold and link these adjustments to quality control measures for medical tests.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#what-will-increase-and-what-will-decrease\" class=\"anchor\" id=\"what-will-increase-and-what-will-decrease\"\u003e\u003c/a\u003eWhat Will Increase and What Will Decrease\u003c/h2\u003e\n\u003ch3\u003e\u003ca href=\"#1-consultation-fees-will-increase\" class=\"anchor\" id=\"1-consultation-fees-will-increase\"\u003e\u003c/a\u003e1. Consultation Fees Will Increase\u003c/h3\u003e\n\u003cp\u003eConsultation fees at clinics are scheduled to be adjusted as follows.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eItem\u003c/th\u003e\n\u003cth\u003eIncrease Rate\u003c/th\u003e\n\u003cth\u003eBefore Adjustment\u003c/th\u003e\n\u003cth\u003eAfter Adjustment\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eInitial Consultation Fee at Clinic Level\u003c/td\u003e\n\u003ctd\u003e6%\u003c/td\u003e\n\u003ctd\u003e18,840 won\u003c/td\u003e\n\u003ctd\u003e19,980 won\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eFollow-up Consultation Fee at Clinics\u003c/td\u003e\n\u003ctd\u003e4%\u003c/td\u003e\n\u003ctd\u003e13,370 won\u003c/td\u003e\n\u003ctd\u003e13,900 won\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eInitial and Follow-up Consultations at Hospitals and Above\u003c/td\u003e\n\u003ctd\u003e2%\u003c/td\u003e\n\u003ctd\u003eVaries by institution\u003c/td\u003e\n\u003ctd\u003eVaries by institution\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe \u003cstrong\u003ein-depth consultations lasting 15 minutes or longer\u003c/strong\u003e, which had been piloted at tertiary general hospitals, will be transitioned into a full-scale program, and the number of applicable sessions will be expanded. In-depth consultations at general hospitals and in-depth primary care consultations lasting 10 minutes or longer in certain medical departments will also be introduced.\u003c/p\u003e\n\u003cp\u003eThe significance of this change is that the system will provide greater reimbursement for “care that involves listening carefully and providing thorough explanations” rather than “care that consists of brief consultations and numerous tests.”\u003c/p\u003e\n\u003ch3\u003e\u003ca href=\"#2-hospitalization-fees-will-increase\" class=\"anchor\" id=\"2-hospitalization-fees-will-increase\"\u003e\u003c/a\u003e2. Hospitalization Fees Will Increase\u003c/h3\u003e\n\u003cp\u003eReimbursement for hospitalization services will also be strengthened.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eItem\u003c/th\u003e\n\u003cth\u003eIncrease Rate\u003c/th\u003e\n\u003cth\u003eMeaning\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eBasic Inpatient Fee for General Wards\u003c/td\u003e\n\u003ctd\u003e7%\u003c/td\u003e\n\u003ctd\u003eExpansion of basic reimbursement for inpatient care on general wards\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eBasic Inpatient Fee for Intensive Care Units (ICUs)\u003c/td\u003e\n\u003ctd\u003e10%\u003c/td\u003e\n\u003ctd\u003eExpansion of reimbursement for critical care requiring intensive staffing and equipment\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe hospitalization fee system will also be revised so that wards requiring more nursing staff receive higher reimbursement. This aims to encourage hospitals to secure more staff for managing inpatients.\u003c/p\u003e\n\u003ch3\u003e\u003ca href=\"#3-regional-preferential-rates-will-be-introduced\" class=\"anchor\" id=\"3-regional-preferential-rates-will-be-introduced\"\u003e\u003c/a\u003e3. Regional Preferential Rates Will Be Introduced\u003c/h3\u003e\n\u003cp\u003eRegional preferential fee rates will be applied in principle to non-metropolitan areas and certain underserved areas within the Seoul metropolitan area. Additional reimbursement will be provided for surgeries, procedures, and emergency care in non-metropolitan areas, as well as in the Uijeongbu, Namyangju, Icheon, and Pocheon regions of Gyeonggi Province, and the Northwest and Central regions of Incheon.\u003c/p\u003e\n\u003cp\u003eThe key details are as follows:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eA 10% surcharge on approximately 2,700 surgeries and procedures at general hospitals and higher-level medical institutions\u003c/li\u003e\n\u003cli\u003eAn additional 10% surcharge for emergency surgeries and procedures performed at night or on holidays\u003c/li\u003e\n\u003cli\u003eRegional preferential fee schedules of up to 20% will be applied in certain areas\u003c/li\u003e\n\u003cli\u003eA 5% surcharge on consultation fees for medical institutions in 84 cities, counties, and districts experiencing population decline\u003c/li\u003e\n\u003cli\u003eAn additional 5% payment on hospitalization fees for general hospitals and hospitals in these areas\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe purpose of this system is to reflect the costs and challenges involved in maintaining essential medical care in these regions, even for the same medical procedures.\u003c/p\u003e\n\u003ch3\u003e\u003ca href=\"#4-compensation-for-critical-and-emergency-final-treatment-will-increase\" class=\"anchor\" id=\"4-compensation-for-critical-and-emergency-final-treatment-will-increase\"\u003e\u003c/a\u003e4. Compensation for Critical and Emergency Final Treatment Will Increase\u003c/h3\u003e\n\u003cp\u003eThe government will invest 900 billion won annually in critical and emergency final treatment. The plan includes a 20% increase in reimbursement rates for approximately 1,600 of the roughly 2,700 surgeries and procedures performed at general hospitals and higher-level facilities, as well as compensation of up to 5.5 times the standard rate for emergency surgeries performed at night or on holidays.\u003c/p\u003e\n\u003cp\u003eReimbursement rates for general anesthesia will also increase by 50% from current levels. This signifies a commitment to compensating not only for the surgery itself but also for the anesthesia, preoperative preparation, and emergency response capabilities that make the surgery possible.\u003c/p\u003e\n\u003ch3\u003e\u003ca href=\"#5-compensation-for-childbirth-and-pediatric-care-will-be-strengthened\" class=\"anchor\" id=\"5-compensation-for-childbirth-and-pediatric-care-will-be-strengthened\"\u003e\u003c/a\u003e5. Compensation for Childbirth and Pediatric Care Will Be Strengthened\u003c/h3\u003e\n\u003cp\u003eFrom the perspective of medical institutions, childbirth and pediatric care involve high staffing burdens and risks, yet demand varies significantly by region, making these fields prone to reduced supply. This reform allocates separate funding to these areas.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eField\u003c/th\u003e\n\u003cth\u003eFunding Allocation\u003c/th\u003e\n\u003cth\u003eKey Details\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eHigh-Risk Pregnant Women and Newborns\u003c/td\u003e\n\u003ctd\u003e100 billion won annually\u003c/td\u003e\n\u003ctd\u003eEnhanced compensation for high-risk deliveries, neonatal intensive care units, and maternal and child health centers\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003ePediatric Care\u003c/td\u003e\n\u003ctd\u003e200 billion won annually\u003c/td\u003e\n\u003ctd\u003eExpansion of the age range for pediatric consultation surcharges; introduction of surcharges for complex pediatric surgeries; enhanced compensation for pediatric intensive care units\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eFor example, for the delivery of a preterm infant born before 28 weeks, a surcharge of approximately 4.4 million won may apply at a specialized maternal and child health center, while at maternal and child health centers outside the Seoul metropolitan area, a surcharge of approximately 5.06 million won may apply, reflecting regional preferential rates. The age range for pediatric consultation surcharges will be expanded from under 6 years old to under 8 years old.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#how-will-ct-mri-and-laboratory-tests-change\" class=\"anchor\" id=\"how-will-ct-mri-and-laboratory-tests-change\"\u003e\u003c/a\u003eHow Will CT, MRI, and Laboratory Tests Change?\u003c/h2\u003e\n\u003cp\u003eThe government is adjusting reimbursement rates for laboratory tests, CT scans, and MRI scans to reduce excessive spending in the diagnostic testing sector.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eItem\u003c/th\u003e\n\u003cth\u003eAdjustment Direction\u003c/th\u003e\n\u003cth\u003eExpected Fiscal Impact\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003eLaboratory tests (blood, urine, etc.)\u003c/td\u003e\n\u003ctd\u003eAdjustment of fees for overcompensation exceeding 150%\u003c/td\u003e\n\u003ctd\u003eAnnual savings of 1.7 trillion won\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eOutsourced testing management fees\u003c/td\u003e\n\u003ctd\u003eAbolition of the system and restructuring of the reimbursement framework\u003c/td\u003e\n\u003ctd\u003eAnnual savings of 200 billion won\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eCT and MRI\u003c/td\u003e\n\u003ctd\u003eAdjustment of items with revenue exceeding 150% of costs\u003c/td\u003e\n\u003ctd\u003eAnnual savings of 700 billion won\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eTotal\u003c/td\u003e\n\u003ctd\u003eAdjustment of excessive spending in testing areas\u003c/td\u003e\n\u003ctd\u003eAnnual savings of 2.6 trillion won\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eHowever, this does not mean that all CT and MRI scans and all tests will be uniformly reduced. The government stated that it will pursue detailed adjustments to ensure that essential tests required for critically ill or emergency patients, as well as tests with a low risk of overtesting, can maintain their current levels.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#the-system-for-outsourcing-laboratory-tests-is-also-changing\" class=\"anchor\" id=\"the-system-for-outsourcing-laboratory-tests-is-also-changing\"\u003e\u003c/a\u003eThe System for Outsourcing Laboratory Tests Is Also Changing\u003c/h2\u003e\n\u003cp\u003eThe system for outsourcing laboratory tests has remained largely unchanged since 1999. Under this structure, outsourcing entities—such as neighborhood clinics—request blood and urine tests, and contracted laboratories perform the actual testing.\u003c/p\u003e\n\u003cp\u003eThe government believes that under the existing system, the combination of overcompensated test items and a discount structure for test fees created incentives for unnecessary testing. Accordingly, it has decided to abolish the outsourcing management fee and instead clearly divide the roles of the outsourcing and contracting institutions within the test fee structure.\u003c/p\u003e\n\u003cp\u003eIn the first phase of the reform, the adjusted test fees will be allocated at a ratio of 35% to the referring institution and 65% to the testing facility. Subsequently, a system involving conditional reimbursement based on evaluations of test quality, patient safety, support for testing in underserved areas, prompt notification of critical results, and specimen tracking and management is under consideration.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#how-will-patient-out-of-pocket-costs-change\" class=\"anchor\" id=\"how-will-patient-out-of-pocket-costs-change\"\u003e\u003c/a\u003eHow Will Patient Out-of-Pocket Costs Change?\u003c/h2\u003e\n\u003cp\u003eFrom the patient’s perspective, the most important question is, “If the fee schedule increases, will my out-of-pocket medical expenses also rise?” The answer is \u003cstrong\u003eit depends on the specific medical service and the patient’s copayment rate\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eHealth insurance fees include both the portion covered by the National Health Insurance Service and the patient’s out-of-pocket copayment. Therefore, if the fee for a service subject to patient copayment increases, the patient’s out-of-pocket costs may also rise slightly. For example, since the statutory copayment rate applies to consultation fees and some hospitalization fees, the actual cost to the patient may change slightly.\u003c/p\u003e\n\u003cp\u003eConversely, for services where fees are reduced—such as CT and MRI scans or laboratory tests—the patient’s out-of-pocket costs may decrease. Additionally, the government explained that for a significant number of items covered by the expanded essential medical care compensation—such as regionally preferential rates, childbirth, and hospitalization fees for children under 2 years of age—patient out-of-pocket costs will either be eliminated or kept low.\u003c/p\u003e\n\u003cp\u003eTo summarize:\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003ePotential Impact on Patients\u003c/th\u003e\n\u003cth\u003eExplanation\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003ePossible partial increase in consultation and hospitalization fees\u003c/td\u003e\n\u003ctd\u003eFor items subject to copayment rates, part of the fee increase may be reflected in the patient’s out-of-pocket costs\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003ePossible partial decrease in testing fees\u003c/td\u003e\n\u003ctd\u003eFor items where fees for laboratory tests, CT scans, and MRIs are reduced, out-of-pocket costs may also decrease\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eSome essential medical services are designed with no out-of-pocket costs for patients\u003c/td\u003e\n\u003ctd\u003eFor regionally preferential rates and certain childbirth, pediatric, and critical care services, out-of-pocket costs may be eliminated or kept low\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003eThe final out-of-pocket cost varies by medical service\u003c/td\u003e\n\u003ctd\u003eIt depends on the type of medical institution, special billing exceptions, out-of-pocket cost reduction programs, and coverage criteria\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003ch2\u003e\u003ca href=\"#what-does-this-mean-for-healthcare-facilities\" class=\"anchor\" id=\"what-does-this-mean-for-healthcare-facilities\"\u003e\u003c/a\u003eWhat Does This Mean for Healthcare Facilities?\u003c/h2\u003e\n\u003cp\u003eThis reform is a policy that changes the revenue structure of healthcare facilities. Revenue models that relied on the turnover rate of diagnostic equipment will decline, while facilities that maintain outpatient care, inpatient care, emergency care, childbirth services, pediatric care, and essential regional medical services will receive additional compensation.\u003c/p\u003e\n\u003cp\u003eIn particular, hospitals outside the Seoul metropolitan area may have a greater incentive to maintain essential care through regionally preferential fee schedules. However, the actual effectiveness must be evaluated in conjunction with factors such as securing medical personnel, bed management, the emergency medical delivery system, resident training environments, and regional demographic structures. It is difficult to assume that regional essential healthcare issues will be fully resolved by fee schedules alone.\u003c/p\u003e\n\u003ch2\u003e\u003ca href=\"#policy-implications-of-this-reform\" class=\"anchor\" id=\"policy-implications-of-this-reform\"\u003e\u003c/a\u003ePolicy Implications of This Reform\u003c/h2\u003e\n\u003cp\u003eThe core of this fee-for-service reform is not to “spend more” on the National Health Insurance budget, but to “spend it differently.” It reduces the relatively high-reimbursement structure centered on diagnostic tests and shifts funds to essential areas where public access would deteriorate significantly if the healthcare system were to collapse.\u003c/p\u003e\n\u003cp\u003eFrom a policy perspective, this has the following implications:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eReform to Reduce Reimbursement Distortions\u003c/strong\u003e: Adjusting high-reimbursement, cost-intensive diagnostic testing areas while increasing reimbursement for under-reimbursed essential care.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eReform Reflecting Regional Disparities\u003c/strong\u003e: Granting additional reimbursement for essential care provided in underserved areas, even for the same medical procedures.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eReform to Enhance the Value of Consultations\u003c/strong\u003e: The system will shift toward rewarding thorough consultations and explanations rather than brief visits.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eImproving the Efficiency of Health Insurance Finances\u003c/strong\u003e: Incentives for unnecessary tests will be reduced, and funds will be allocated to high-priority areas such as severe cases, emergencies, childbirth, and pediatrics.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTransition to a Continuous Adjustment System\u003c/strong\u003e: The current relative value revision cycle, which runs every 5 to 7 years, will be shortened to an adjustment system occurring within two years to more quickly reflect changes in medical technology and costs.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003e\u003ca href=\"#key-issues-to-monitor-going-forward\" class=\"anchor\" id=\"key-issues-to-monitor-going-forward\"\u003e\u003c/a\u003eKey Issues to Monitor Going Forward\u003c/h2\u003e\n\u003cp\u003eThis announcement establishes the broad direction, and the actual impact on healthcare settings and patient out-of-pocket costs will be further clarified through detailed regulations and the implementation process. In particular, the following issues require ongoing monitoring:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eWill the adjustment of CT and MRI fees reduce access to these necessary tests?\u003c/li\u003e\n\u003cli\u003eWill the increase in consultation fees lead to an actual increase in consultation time?\u003c/li\u003e\n\u003cli\u003eAre regional preferential fees sufficient to secure essential medical personnel outside the Seoul metropolitan area?\u003c/li\u003e\n\u003cli\u003eWill enhanced compensation for obstetrics and pediatrics actually improve the sustainability of hospital operations?\u003c/li\u003e\n\u003cli\u003eDoes the reform of the diagnostic testing outsourcing system improve test quality and patient safety?\u003c/li\u003e\n\u003cli\u003eHow will patient copayments change for each service item?\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e\u003ca href=\"#summary\" class=\"anchor\" id=\"summary\"\u003e\u003c/a\u003eSummary\u003c/h2\u003e\n\u003cp\u003eThe government’s reform of the National Health Insurance fee-for-service system is a policy aimed at reducing the test-centric reimbursement structure and reallocating funds toward regional and essential healthcare. It aims to save 2.6 trillion won annually from laboratory tests, CT scans, and MRIs, and, by adding 1 trillion won from the National Health Insurance budget, invest a total of 3.6 trillion won annually in outpatient care, hospitalization, emergency care, obstetrics, pediatrics, and post-acute care.\u003c/p\u003e\n\u003cp\u003ePatients may experience different effects depending on the specific medical services they receive. While consultation fees and some hospitalization fees may rise slightly, the financial burden may decrease for services where testing fees are reduced. Although the government maintains that the reform is designed to prevent an overall increase in out-of-pocket costs, the actual impact will vary depending on the detailed implementation guidelines and each individual’s specific treatment.\u003c/p\u003e\n","tags":["Health insurance","Medical fee reform","Essential healthcare","Regional healthcare","Healthcare policy"],"faqs":[{"question":"Health Insurance](https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1491009\u0026mid=a10503010100\u0026nPage=1\u0026tag=https://www.korea.kr/news/policyNewsView.do?newsId=148967170https://www.korea.kr/news/policyNewsView.do?newsId=148967195https://www.korea.kr/briefing/policyBriefingView.do?newsId=156768110https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1488346\u0026mid=a10503010100\u0026nPage=6\u0026tag=%22,%22faqs%22:[{%22question%22:%22What is the fee schedule for health insurance?","answer":"Health insurance fees are the price list for medical treatments, tests, surgeries, hospitalizations, and other services covered by health insurance. Patients pay a portion of the cost, and the National Health Insurance Service covers the remainder."},{"question":"What is the key point of this health insurance fee schedule reform?","answer":"The goal is to reduce reimbursement rates for tests—such as laboratory tests, CT scans, and MRIs—and increase reimbursement rates for regional and essential medical services, such as outpatient visits, hospitalizations, emergency care, childbirth, and pediatric care."},{"question":"Why are CT and MRI fees being lowered?","answer":"This is because a government analysis found that specialized imaging tests, such as CT and MRI scans, are overreimbursed items with a high cost-to-benefit ratio. The government has announced that it will focus its adjustments on items with a cost-to-benefit ratio of 150% or higher."},{"question":"Will all the exam fees be reduced?","answer":"This does not mean that all tests will be cut across the board. The government explained that while it will focus on adjusting items subject to overreimbursement, it will implement detailed adjustments to ensure that essential tests required for critically ill and emergency patients, as well as tests with a low risk of overuse, can be maintained at current levels."},{"question":"How much will the consultation fee at a local clinic go up?","answer":"The consultation fees for initial visits at clinics are set to increase by 6%, and those for follow-up visits by 4%. According to the announcement, the fee for an initial visit at a clinic will be adjusted from 18,840 won to 19,980 won, and the fee for a follow-up visit from 13,370 won to 13,900 won."},{"question":"Will the medical costs patients have to pay also go up?","answer":"It varies by service. Consultation fees and some hospitalization fees, to which copayment rates apply, may rise slightly, while patient out-of-pocket costs for services with reduced fees—such as CT and MRI scans and laboratory tests—may decrease. The government has stated that it intends to design the system so that total out-of-pocket medical expenses do not increase."},{"question":"What is the regional preferential rate?","answer":"This is a program that provides additional compensation to medical institutions offering essential care in non-metropolitan areas and certain underserved areas within the Seoul metropolitan area. The additional compensation applies to surgeries and medical procedures, emergency surgeries performed at night or on holidays, high-risk deliveries, and neonatal intensive care units."},{"question":"How do obstetrics and pediatrics differ?","answer":"Compensation for the treatment of high-risk pregnant women and newborns will be increased to 100 billion won annually, and compensation for pediatric care will be increased to 200 billion won annually. The age range eligible for pediatric consultation surcharges will be expanded from under 6 years old to under 8 years old, and reimbursement for pediatric major surgeries and pediatric intensive care units will also be increased."},{"question":"When will this reorganization take effect?","answer":"The government announced that, following preparatory work, it plans to implement the measures in phases starting in December 2026. Some initiatives, such as increased compensation for maternal and child health centers, are scheduled to be implemented first, starting in the third quarter of 2026."},{"question":"Will this reorganization alone solve the problem of essential healthcare in rural areas?","answer":"While the revision of reimbursement rates is an important financial incentive, the issue of essential healthcare in rural areas is also linked to healthcare personnel, hospital beds, the emergency medical care delivery system, resident training, and the local demographic structure. Therefore, to assess its actual effectiveness, we must examine changes in the operations of medical institutions and patient access following its implementation."}],"sources":[{"url":"https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1491009\u0026mid=a10503010100\u0026nPage=1\u0026tag=","title":"Ministry of Health and Welfare](https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1491009\u0026mid=a10503010100\u0026nPage=1\u0026tag=%22,%22title%22:%22Ministry of Health and Welfare) Press Release: 3.6 trillion won in National Health Insurance funds to be allocated annually to regional and essential healthcare; largest-ever reform of the National Health Insurance fee-for-service structure","type":"source"},{"url":"https://www.korea.kr/news/policyNewsView.do?newsId=148967170","title":"[Republic of Korea](https://www.korea.kr/news/policyNewsView.do?newsId=148967170%22,%22title%22:%22대한민국) Policy Briefing: Significant Increase in Reimbursements for Regional and Essential Healthcare… Comprehensive Overhaul of the National Health Insurance Fee Schedule","type":"source"},{"url":"https://www.korea.kr/news/policyNewsView.do?newsId=148967195","title":"[Republic of Korea](https://www.korea.kr/news/policyNewsView.do?newsId=148967195%22,%22title%22:%22대한민국) Policy Briefing: 3.6 trillion won in health insurance funds to be allocated annually to regional and essential healthcare","type":"source"},{"url":"https://www.korea.kr/briefing/policyBriefingView.do?newsId=156768110","title":"[Republic of Korea](https://www.korea.kr/briefing/policyBriefingView.do?newsId=156768110%22,%22title%22:%22대한민국) Policy Briefing: Briefing on Measures to Reform the Health Insurance Fee Structure","type":"source"},{"url":"https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1488346\u0026mid=a10503010100\u0026nPage=6\u0026tag=","title":"Ministry of Health and Welfare](https://www.mohw.go.kr/board.es?act=view\u0026bid=0027\u0026list_no=1488346\u0026mid=a10503010100\u0026nPage=6\u0026tag=%22,%22title%22:%22Ministry of Health and Welfare) Press Release: Ministry to Pursue Ongoing Adjustments to Relative Values in 2026 Based on Medical Cost Analysis Results and Other Factors","type":"source"}],"images":[{"id":36,"url":"https://injoys.com/rails/active_storage/blobs/redirect/eyJfcmFpbHMiOnsiZGF0YSI6MzY4LCJwdXIiOiJibG9iX2lkIn19--8848706f5efb1f895034e927d6002db7fbc3e044/ai-51fe85a7.webp","is_representative":true,"generation_method":"ai_image","license":"ai_generated","mime_type":"image/webp","translations":{"ko":{"alt":"검사 장비와 필수의료 시설을 양쪽에 올린 의료 저울 일러스트","caption":"검사 중심 수가에서 지역·필수의료 지원으로 균형을 옮기는 변화를 보여준다.","description":null},"en":{"alt":"Medical scale balancing test equipment against essential care services","caption":"The illustration suggests a shift from test-based fees toward regional and essential care.","description":null},"ja":{"alt":"検査機器と必須医療サービスを載せた医療の天秤イラスト","caption":"検査中心の評価から地域・必須医療へ重点を移す流れを示している。","description":null},"es":{"alt":"Balanza médica con equipos de pruebas y servicios de atención esencial","caption":"La ilustración muestra el cambio de las pruebas hacia la atención regional y esencial.","description":null},"id":{"alt":"Timbangan medis berisi alat pemeriksaan dan layanan kesehatan esensial","caption":"Ilustrasi ini menunjukkan pergeseran dari tarif berbasis pemeriksaan ke layanan regional dan esensial.","description":null},"pt":{"alt":"Balança médica com exames de um lado e cuidados essenciais do outro","caption":"A ilustração indica a mudança de exames para cuidados regionais e essenciais.","description":null},"zh-hant":{"alt":"醫療天平兩端放著檢查設備與基本醫療服務","caption":"插圖呈現給付重心從檢查轉向地區與基本醫療。","description":null}}},{"id":37,"url":"https://injoys.com/rails/active_storage/blobs/redirect/eyJfcmFpbHMiOnsiZGF0YSI6Mzc0LCJwdXIiOiJibG9iX2lkIn19--328f4772b25cba03519e67b7a0fbc5c971cce785/ai-3722581e.webp","is_representative":false,"generation_method":"ai_image","license":"ai_generated","mime_type":"image/webp","translations":{"ko":{"alt":"검사실과 영상장비에서 지역 의료기관으로 자원이 이어지는 의료체계 일러스트","caption":"검사 중심 자원이 여러 지역 병원과 필수의료 현장으로 연결되는 모습을 보여준다.","description":null},"en":{"alt":"Healthcare network linking labs and imaging equipment to regional clinics and hospitals","caption":"The illustration shows resources flowing from tests to local hospitals and essential care sites.","description":null},"ja":{"alt":"検査室と画像診断装置から地域の医療機関へ資源がつながる医療ネットワーク","caption":"検査中心の資源が地域の病院や必須医療の現場へ広がる様子を示している。","description":null},"es":{"alt":"Red sanitaria que conecta laboratorios y equipos de imagen con clínicas y hospitales regionales","caption":"La ilustración muestra recursos que pasan de las pruebas a hospitales locales y atención esencial.","description":null},"id":{"alt":"Jaringan kesehatan yang menghubungkan laboratorium dan pemindaian dengan klinik serta rumah sakit daerah","caption":"Ilustrasi ini menunjukkan sumber daya dari pemeriksaan mengalir ke layanan esensial di daerah.","description":null},"pt":{"alt":"Rede de saúde ligando laboratórios e exames de imagem a clínicas e hospitais regionais","caption":"A ilustração mostra recursos saindo dos exames para hospitais locais e cuidados essenciais.","description":null},"zh-hant":{"alt":"檢驗室與影像設備連結各地診所和醫院的醫療網絡","caption":"圖中呈現資源從檢查端流向地方醫院與必要醫療服務。","description":null}}}],"published_at":"2026-07-05T10:08:51+09:00","updated_at":"2026-07-05T10:08:51+09:00","license":"cc_by","translation_status":"reviewed","available_locales":["ko","en","ja","es"],"data_locales":["ko","en","ja","es","id","pt","zh-hant"],"url":"https://injoys.com/en/articles/korea-health-insurance-fee-reform-essential-care-2026"}