Out-of-pocket rates for patients with rare and severe intractable diseases to fall from 10% to 7%, cutting hospital bills for 1.36 million

[Financial News] Starting next month, patients with rare and severe intractable diseases will pay more than 200,000 won less a year in hospital costs. As the health insurance copayment rate falls from 10% to 7%, the average annual out-of-pocket payment per patient is expected to drop from about 750,000 won to about 530,000 won.
The Ministry of Health and Welfare (MOHW) said it would issue a legislative notice from the 4th through the 16th on a partial amendment to the Enforcement Decree of the National Health Insurance Act. About 1.36 million patients with rare and severe intractable diseases registered under the special copayment program will benefit.

Rare and severe intractable diseases are difficult to cure and require long treatment periods, causing medical expenses to mount for patients and their families. The government has applied the special copayment program to these patients. The program lowers the health insurance copayment rate for patients facing high medical costs; the rate for general patients is 20% for inpatient care and 30–60% for outpatient care. However, the 10% rate for patients with rare and severe intractable diseases was higher than the 5% rate for patients with other severe diseases, including cancer and cardiovascular and cerebrovascular diseases.
This amendment is the first step in the phased reduction of copayment rates (10%→7%→5%) approved by the National Health Insurance Policy Deliberation Committee last September. The government plans to lower the rate to 7% this December and then to 5% in the first half of 2028.

The reduced copayment rate will apply to health insurance-covered medical expenses when patients receive treatment for the relevant diseases. Out-of-pocket costs for non-covered care and the patient share of meal costs during hospitalization (50%) will remain unchanged.
MOHW plans to gather public comments during the legislative notice period, then proceed with a review by the Ministry of Government Legislation (MOLEG) and a resolution by the State Council of South Korea before implementing the change for care received in December. Organizations or individuals wishing to comment can submit their views by the 16th through the National Legislation Participation Center or to MOHW's Insurance Policy Division. Details of the amendment are available on the MOHW website under “Information → Laws and Regulations → Legislative/Administrative Notices and e-Public Hearings.”
Yu Ju-heon, director general of MOHW's Health Insurance Policy Bureau, said, “This amendment is the first step toward lowering the out-of-pocket burden for patients with rare and severe intractable diseases to the level for patients with other severe diseases,” adding, “We will swiftly complete the remaining procedures to ensure the Dec. 1 implementation proceeds without a hitch.” 

[email protected] Jung Myung-jin, Medical Correspondent Reporter