Patient Copayments to Rise to 90% for More Than 300 Hospital Visits a Year... “Curbing Excessive Medical Use”

[Financial News] South Koreans make an average of 17.9 outpatient visits per year, 2.7 times the OECD average of 6.6. To reduce excessive medical use, the government will raise the patient copayment rate to 90% starting next year for more than 300 outpatient visits annually. This is equivalent to using medical institutions about six times a week.
The Ministry of Health and Welfare (MOHW) said the State Council of South Korea approved on the 8th a partial amendment to the Enforcement Decree of the National Health Insurance Act.
Of the approximately 48.4 million outpatient users last year, 7,765 made more than 300 visits during the year. They averaged about 344.7 outpatient visits annually, and some cases involved extremely frequent use, including one person who made 1,775 visits in a year.
However, existing safeguards will remain in place for patients who cannot avoid frequent outpatient visits because of their treatment needs. Children, pregnant women, severely disabled persons covered by special calculation rules, and patients receiving treatment for severe, rare, or severe intractable diseases will be exempt. Even when patients do not meet these exemption criteria, the National Health Insurance Service (NHIS) Excessive Medical Use Review Committee may grant an exception after reviewing medical necessity and other factors.
Starting in October, the eligibility requirements for employee-insured subscribers to apply for installment payments on additional year-end insurance premium settlements will also be eased. Currently, up to 12 installments are available only when the additional premium is at least equal to the employee’s share of the monthly standard-wage premium. Going forward, applications will be allowed when the additional premium is at least the lower limit of the monthly standard-wage premium, which is 10,080 won as of 2026.
Yoo Ju-heon, director general of the Health Insurance Policy Bureau, said, "This amendment is intended to ensure sufficient coverage for medically necessary care while reducing patient safety risks caused by repeated and excessive medical use and helping people use medical services more appropriately. As it will also ease the burden of making insurance premium settlements in a lump sum and reduce the reporting burden on workplaces, we will prepare without disruption so that people can feel the changes in practice."
 
[email protected] Medical Specialist Jung Myung-jin Reporter