Health ministry sets 2.7 trillion won in fee hikes for regional care

South Korea's health ministry said Wednesday it will begin directing 2.7 trillion won ($2.04 billion) a year into higher fees for essential and regional medical care from January 2027, the largest restructuring of the national health insurance fee schedule since the current system was introduced in 2001.

The plan approved by the Health Insurance Policy Deliberation Committee at its 19th meeting of the year commits the timing of the first slice of a broader 3.6 trillion won annual investment package. The remaining 900 billion won ($680 million) will be scheduled after further committee discussion later this year.

The money will be shifted from tests that the government says earn far more than they cost. Fees for blood and other specimen tests will fall 28 percent and those for CT and MRI scans 25 percent, saving 2.6 trillion won ($1.96 billion) a year — 1.7 trillion won from specimen tests, 200 billion won from abolishing a handling fee for outsourced tests and 700 billion won from imaging.

For patients, the most visible change is in the consultation fee. The first-visit fee at a local clinic will rise 6 percent, the first increase in 20 years, taking it to 19,980 won ($15) from 18,840 won, and the repeat-visit fee will go up 4 percent. Hospitals and larger institutions will raise both by 2 percent.

Inpatient fees, unchanged for more than a decade, will rise 7 percent for general wards and 10 percent for intensive care units. The top-tier intensive care rate at a major hospital will climb to 798,000 won ($603) a day from 668,000 won.

Doctors will be paid more for the hardest work. Fees for 1,670 severe surgeries and procedures — 61 percent of all surgical items — will rise 20 percent, and emergency, night and holiday premiums will go from 350 percent to 450 percent, or as much as 470 percent outside the capital region and in vulnerable areas.

A regional weighting will add 10 percent to procedures in areas outside the Seoul metropolitan area and in six designated weak spots, with a further 10 percent for night, holiday and emergency care. High-risk deliveries at maternal care centers will draw an extra 100 percent, and neonatal intensive care 50 percent, starting in January 2027, with the surgery premium following in March.

Hospitals that take emergency transfers of high-risk births before 34 weeks will receive a 3.3 million won ($2,492) fee, including an extra 660,000 won outside the capital region, while neonatal intensive care units will receive a daily supplement of up to 1.91 million won, for a maximum of seven days.

The ministry also approved conditional payments for clinics that send specimens to outside laboratories. Institutions that meet quality requirements will receive up to four payments of 1,400 won a year per patient for analysing and managing results, as part of a two-year pilot.

"Innovating health insurance fees is an essential step toward strengthening regional and essential medical care," the ministry said, adding that it will keep managing the programme so it can be carried out without disruption.