Starting in July, if a patient receives outpatient treatment more than 365 times annually, their self-payment rate will be adjusted to 90%.
According to the Ministry of Health and Welfare on the 27th, the revised ‘National Health Insurance Act Enforcement Decree’ containing this provision will go into effect on July 1.
According to the revision, patients who exceed 365 outpatient visits annually will have to cover 90% of the total outpatient treatment costs. The Ministry of Health and Welfare explains that this measure aims to promote rational use of healthcare and prevent waste of medical resources due to unnecessary healthcare utilization. However, minors under 18, pregnant women, persons with disabilities, patients with rare and intractable diseases, and patients with serious illnesses who require outpatient treatment exceeding 365 visits annually are exempt from this provision.
Typically, the self-payment rate for outpatient treatment after health insurance coverage is around 20%. However, for individuals with privately purchased expenses-paid insurance, the effective self-payment rate is reduced to 0-4%. Some patients are reported to excessively utilize medical services beyond what is necessary.
The Ministry of Health and Welfare also plans to introduce a service that informs health insurance subscribers of their cumulative outpatient visits, hospitalization days, health insurance benefits, and self-payment information via KakaoTalk, Naver, and ‘The National Health Insurance’ app.