Non-covered treatment shifted to managed benefit; patients to bear 95% of cost

Government to review session limits in second half amid concerns over patient access

Manual therapy [Yonhap]
Manual therapy [Yonhap]

The government Tuesday began enforcing a new regime that brings manual therapy — a treatment whose costs had varied widely across clinics — under national health insurance as a managed benefit, capping coverage at 15 sessions per year.

The measure is designed to curb overtreatment and standardize fees. However, concerns that it could restrict access for patients requiring long-term care have prompted the government to consider revising the system in the second half of the year.

According to the Ministry of Health and Welfare, manual therapy transitions from a non-covered service to a managed benefit starting Tuesday. The managed-benefit category applies to treatments deemed medically necessary but subject to high patient co-payments to discourage excessive use.

The standard price per session has been set at 43,850 won ($28), with patients responsible for 95 percent of that amount. Previously, prices differed significantly by clinic, with the average session costing around 110,000 won.

The government said manual therapy has some recognized therapeutic value but is largely elective and supplementary in nature, and that persistent price disparities and misuse across medical institutions made regulation necessary.

Coverage is limited to two sessions per week and 15 per year. However, patients with clearly documented joint contracture or rigidity following surgery or a fracture may receive coverage for up to 24 sessions annually at a physician's discretion. Because the system takes effect in July, the full annual limit will apply through the end of this year.

Manual therapy performed for purposes not recognized as medically necessary — such as fatigue relief or body-shape correction — will be excluded from both national health insurance and private loss insurance. Such sessions remain available without a cap, but patients must cover the full cost themselves.

The government also requires that basic rehabilitation or physical therapy be administered for about two weeks before manual therapy is attempted, with manual therapy reserved for cases where those initial treatments prove ineffective. Clinics are now obligated to assess treatment outcomes and maintain detailed medical records.

The Ministry of Health and Welfare expects the overhaul to stabilize manual therapy prices and reduce overtreatment.

At the same time, concerns are growing that patients with chronic pain or long-term treatment needs could face greater hardship as some clinics scale back or discontinue manual therapy services.

Ko Hyong-woo, the ministry's essential medical care support director, said consultations with medical associations indicated that an appropriate annual session range was 15 to 24. "Looking at private insurance data, the average number of manual therapy sessions per year is 12, meaning a limit of 15 would cover about 95 percent of patients," he said.

The government plans to evaluate the system's performance after implementation and assess whether adjustments are needed. On the session limits — which have drawn the most criticism over patient treatment rights — the ministry intends to hold discussions with the medical community in the second half of the year and develop remedial measures.

"We will review feedback from the field, and if there are reasonable alternatives for patients who need more sessions, we will consider expanding access," said Jo Mi-hee, head of the benefit strategy division at the Health Insurance Review and Assessment Service. "There has been significant concern about patient treatment rights, and we plan to discuss system improvements with medical associations in the second half of the year."


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