10th Health Insurance Policy Deliberative Committee meeting also advances rural healthcare fee pilot program

Vice Minister of Health and Welfare Lee Hyeong-hun speaks at the 10th Health Insurance Policy Deliberative Committee meeting held Thursday at the International Electronics Center in Seocho-gu, Seoul. [Ministry of Health and Welfare]
Vice Minister of Health and Welfare Lee Hyeong-hun speaks at the 10th Health Insurance Policy Deliberative Committee meeting held Thursday at the International Electronics Center in Seocho-gu, Seoul. [Ministry of Health and Welfare]

Starting next month, the price of spinal manipulation therapy — which has varied widely across clinics — will be standardized at 43,850 won (about $32) per session, with annual visits capped at 24.

A pilot program will also introduce fee schedules for remote collaborative consultations and other services in rural areas where healthcare access has declined sharply amid a dwindling supply of public health doctors.

The Ministry of Health and Welfare announced the decisions Thursday after convening the 10th Health Insurance Policy Deliberative Committee meeting of the year.

Spinal manipulation under 'managed benefit': 43,850 won per 30-minute session, 15 visits per year as baseline

The ministry established fee rates and coverage criteria for spinal manipulation therapy under the new "managed benefit" category at Thursday's committee meeting.

The managed benefit framework designates certain medical procedures as provisional national health insurance items requiring utilization oversight. Patients bear 95 percent of the cost under this category.

The committee set the standard price for a 30-minute spinal manipulation session at 43,850 won, to be applied uniformly across all types of medical institutions.

Before performing spinal manipulation, medical institutions must first administer basic physical therapy or simple rehabilitation treatment.

Sessions are limited to twice a week and 15 times per year, regardless of the body part being treated. However, a physician may authorize up to 24 sessions annually — inclusive of the baseline 15 — based on medical judgment.

Each medical institution must submit relevant treatment records to the Health Insurance Review and Assessment Service through the spinal manipulation management system after performing the therapy.

The ministry plans to evaluate the coverage criteria on a three-year cycle and will develop more detailed standards at each review.

"The managed benefit system is designed to address the problem of overtreatment in some non-covered procedures and to encourage medically appropriate care based on clinical necessity," the ministry said. "Starting with spinal manipulation therapy, we will gradually strengthen the framework for managing non-covered services to minimize the financial burden on patients."

Rural healthcare fee pilot launched amid shortage of public health doctors; home-care programs consolidated

The committee also agreed Thursday to launch a fee pilot program for rural healthcare services, where access has deteriorated due to a sharp decline in the number of public health doctors.

The government has drawn up measures to address regional medical gaps caused by the falling number of public health doctors. Under those measures, dedicated civil servant healthcare workers — registered nurses — are now providing medical services at 160 integrated community health subcenters, as of end of April, located near primary health posts.

The rural healthcare fee pilot is a follow-up to those measures. It will apply a per-visit fee of at least 3,980 won — based on the primary health post standard — to services provided by dedicated civil servant workers at integrated community health subcenters.

When a dedicated civil servant worker conducts a remote collaborative consultation with a physician, the relevant medical institution will receive a remote consultation advisory fee ranging from 17,500 won to 21,440 won, depending on the type of institution.

The committee also decided to consolidate home-care pilot programs that had been operating separately by disease category.

The home-care pilot programs provide education, counseling and remote patient management services to patients with conditions requiring self-management outside of medical institutions. They have been running across seven disease groups, including type 1 diabetes and heart disease.

The ministry will rename the individual disease-specific pilots under the unified title "Disease-Specific Home Care Pilot Program" and simplify the previously varying fee calculation standards and patient cost-sharing rates by grouping similar conditions together.

Patients with implantable left ventricular assist devices (LVADs) will also be added to the heart disease category covered by the pilot, and the end dates of the various programs — which had differed — will be unified to December next year.


thlee@heraldcorp.com