Innovative medical technologies, such as digital treatment devices and diagnostic aids using artificial intelligence, have been decided to receive insurance benefits.
The Ministry of Health and Welfare deliberated and approved the “Plan for Medical Benefits for Digital Therapeutic Devices and AI Innovative Medical Technologies” at the Health Insurance Policy Deliberation Committee on Thursday.
In July, the Ministry of Health and Welfare reported the principle of temporarily assigning health insurance codes to digital therapeutic devices and innovative AI medical technologies to the Health Insurance Policy Deliberation Committee. Later, The ministry discussed the issue and determined the fees befitting each area’s characteristics.
In the case of the artificial intelligence field, the ministry will compensate for each product at the level of 10 percent of the reading by an imaging specialist, considering that it is a technology that requires diagnostic assistance and clinical field utilization.
Accordingly, pathology tests are priced at 2,920 won ($2.15), special imaging diagnostics, such as CT and MRI, at 1,810 won, endoscopy and ultrasound at 1,180 won, and others at 310 won.
The fee is paid as an add-on, considering the time and frequency of clinical examinations for each field. An additional amount is applied if the potential value of the innovative medical device is highly evaluated during the review and evaluation process, according to the ministry.
In addition, when applied as a non-reimbursement, the field applies an upper limit to prevent excessive patient burden.
Considering the need to manage digital therapeutic devices for mental and chronic diseases effectively, the ministry will establish a new fee for medical staff.
Therefore, the prescription fee for digital therapeutic devices is 5,230 won for expanding the device and educating on its use when first prescribed, and 16,130 won for evaluating the effectiveness of digital therapeutic devices, a comprehensive compensation for checking the patient's usability, evaluating the treatment effect, and operating the treatment plan after the use is completed.
In addition, considering that outpatient-centered explanation, education, and evaluation are carried out, the same price is compensated regardless of the type of device and whether it is paid or non-paid. Still, the ministry will actively monitor it at the beginning of its introduction.
The committee also decided to assign a preliminary code to “AI-based ischemic stroke type determination using magnetic resonance imaging” and not reimburse it. The decision is the first health insurance application for innovative medical technology in the field of artificial intelligence.
"The decision is very significant as it specifically establishes a system to allow innovative technologies to be used in the field," the ministry said. "We will closely observe the status of future use and continue to collect and supplement field opinions."