S.Korea's medical overhaul raises concerns over patient access

South Korea's overhaul of its public health insurance reimbursement system, aimed at curbing medical spending, has raised concerns about restricting patient access to treatments like manual therapy and diagnostic tests. Doctors warn that lower reimbursement rates and session caps may discourage hospitals from offering these services, while patients argue the policy primarily benefits private insurers by shifting costs to the public system.

South Korea's sweeping overhaul of its public health insurance reimbursement system has triggered concerns over potentially restricting patients' access to treatments and diagnostic services. Doctors have warned that the change initially implemented to curb medical spending could discourage hospitals and clinics from offering services such as manual therapy and diagnostic tests. Last week, a university hospital in Gangnam, southern Seoul, announced that it would discontinue manual therapy starting Wednesday after the treatment was included in the new category of the National Health Insurance system. The new category includes treatments that previously were not reimbursed, with the intent to regulate fees and standards to prevent what some call "over-treatment." Manual therapy — adjusting muscles and joints to relieve pain and restore alignment — is widely used for musculoskeletal disorders caused by injuries, repetitive strain and post-surgical rehabilitation. Under the new rules, the government sets both the reimbursable fee and the maximum number of sessions covered each year. The hospital said it would instead seek alternative treatments for patients who require continued care. New system limits certain treatments Several families with children suffering from congenital muscular torticollis have said online that their clinics had informed them that manual therapy would no longer be available from July, indicating that the change is affecting medical institutes across the country. "Starting in July, the government says manual therapy can only be used as a supplementary treatment after other treatments have failed. But those preliminary treatments are not even feasible for a five-month-old baby," one parent wrote while sharing a notice from a clinic. Manual therapy has flourished in recent years in South Korea, as many private indemnity insurance plans reimbursed the treatment with virtually no limit on the number of sessions. However, mounting losses at private insurers driven by excessive claims for manual therapy, together with complaints over wide price differences between medical institutions, prompted the government to bring the treatment under the NHIS reimbursement framework. Under the new scheme, patients will receive reimbursement for 95 percent of the government-set fee. At the same time, the reimbursable price has been fixed at 43,850 won $28.50 per session, well below the previous average charge of 113,296 won, while the number of reimbursable sessions has been capped at 24 per year. Patients argue that the policy mainly benefits private insurers by shifting costs into the public insurance system; medical providers say the lower reimbursement makes it difficult to continue offering the service. "Although manual therapy is a specialized medical service requiring experienced practitioners as well as considerable time and manpower, the reimbursement set by the government does not adequately reflect those realities," an official from the Korean Neurosurgical Society told local media. Kim Kyung-jin, president of the Korea Association of Manual Medicine, also criticized the policy, arguing that the government has effectively transferred costs previously borne by private insurers onto the NHIS and ultimately the public. Concerns are also growing over another reimbursement reform announced Wednesday, under which the government plans to reduce payments for laboratory tests and imaging services while increasing compensation for essential and primary care. The proposal would lower reimbursement for laboratory testing by up to 28 percent and for computed tomography and magnetic resonance imaging by about 25 percent by 2028, saving an estimated 2.6 trillion won annually. Medical groups and some patients warn that lower reimbursement could reduce the availability of preventive screening and diagnostic testing, potentially undermining one of the strengths of South Korea's healthcare system. They argue that comprehensive health checkups have long played a key role in detecting diseases early and helping patients obtain accurate diagnoses. "Nobody enjoys drinking contrast agents and undergoing CT scans," said a woman in her 60s who said she had visited several hospitals after receiving conflicting interpretations of her scans. "Patients undergo additional tests to obtain a more accurate diagnosis. If reimbursement is simply reduced, I'm worried it could ultimately lower the quality of diagnostic readings." forestjs@heraldcorp.com