South Korea National Health Insurance reforms

South Korea is implementing several updates to its National Health Insurance system, focusing on expanding coverage for critical treatments while managing fund sustainability.

In early September, the government expanded coverage for specific blood cancer treatments, including Polivy for certain adult lymphoma patients and Blincyto for specific leukemia cases. Additionally, the Health Insurance Review and Assessment Service clarified reimbursement standards for Hemlibra, a treatment for severe Hemophilia A, establishing specific protocols for administration and patient requirements.

Following these updates, the Ministry of Health and Welfare announced plans to freeze employee health insurance premium rates at 7.19% due to a fund surplus. The government also intends to reduce out-of-pocket expenses for approximately 1.97 million patients with severe or rare incurable diseases, lowering co-payments from 10% to 5% by 2028. Further coverage expansions will include severe type 2 diabetes, dental implants for seniors, and resin treatments for children.

To prevent excessive medical use, new regulations will take effect in January, imposing a 90% co-payment rate on individuals exceeding 300 outpatient visits per year, excluding vulnerable groups such as children and pregnant women. To support this, a system allowing medical institutions to verify patient histories across providers will begin rolling out in December.