Starting in October, the government will reduce health insurance coverage for brain and cerebrovascular MRI examinations.
The Ministry of Health and Welfare said Monday it has revised the notice on “details on the application standards and methods of benefits” to that effect. The revised notice will take effect on Oct. 1 after a grace period, considering the need for preparation in the medical field.
The revised notice toughens the criteria for health insurance coverage for brain and cerebrovascular MRIs due to headaches and dizziness.
Only headaches and dizziness with suspected brain diseases. such as cerebral hemorrhage and cerebral infarction, will be covered by health insurance for MRI examinations. Suppose a doctor determines that an MRI is not medically necessary despite symptoms like migraines or chronic headaches. In that case, health insurance will not cover the MRI if the patient wants and receives it.
However, if the patient has a confirmed brain disease or abnormal findings in neurological tests, the MRI examination will continue to get coverage as before.
The notice’s revision is a follow-up to the “plan to enhance health insurance sustainability” announced in February.
The ministry has pushed for an overall review of coverage items following concerns that the previous government’s “measures to strengthen health insurance coverage” had led to a surge in the use of MRI and ultrasound examinations, which could undermine the sustainability of health insurance.
Through the Reimbursement Standard Improvement Council, with the participation of specialized medical societies, the ministry has prepared a revised standard based on medical necessity for brain and cerebrovascular MRI examinations, which have seen a surge in a short period.
The revision was decided on May 30 after discussions at the Health Insurance Policy Review Committee. It was finalized after undergoing a prior administrative notice.
“Due to the rapid strengthening of coverage for expensive imaging tests, including MRIs, some unnecessary tests have been conducted," said Jeong Yoon-soon, director-general of the ministry’s Health Insurance Policy Bureau. “With the revision of the notice, expensive imaging tests will be covered by health insurance only when necessary, and the financial savings will be used to strengthen health insurance finances and invested in valuable areas, such as serious diseases and essential medical care."
The ministry will continue to check and improve the leakage factors of health insurance finances to ensure the sustainability of health insurance, and that the saved finances can be used to strengthen the foundation of essential medical care directly related to people's lives, Jeong added.