The government announced on Wednesday that it plans to unveil measures to improve the management of non-reimbursed treatments and the actual cost insurance system by the end of December.

Although specific measures have not been finalized, sources indicated that the plans are expected to include a ban on mixed medical billings (combining reimbursed and non-reimbursed treatments) and the introduction of reference prices for fully out-of-pocket treatments, as outlined in the first action plan of the Special Committee on Healthcare Reform.

At a news conference, the Ministry of Health and Welfare and the Financial Services Commission shared updates on discussions to improve uncovered treatments and the actual cost insurance system, which is predominantly funded by insurance companies.

Earlier, a vernacular business paper reported that the government intends to ban mixed medical billings to enhance the actual cost insurance system. The report, citing the presidential office and government officials, also suggested that discussions are underway to provide the legal basis for the ban in the Medical Service Act and the Health Insurance Act.

Sources noted that policymakers are also considering introducing a reference price system to address the varying costs of uncovered treatments across hospitals. The government would periodically publish these benchmark prices.

“The Ministry of Health and Welfare and the Financial Services Commission, through the Special Committee on Healthcare Reform, have received various proposals to better manage excessive uncovered treatments for non-severe cases and the actual cost insurance system. These proposals are being reviewed in consultation with private experts and consumer organizations,” officials stated at the news conference.

“The finalized plan to improve payments for uncovered and fully insured treatments will be announced after further discussions with the special committee in late December,” they added, emphasizing that specific details are still under review.

However, the government has already expressed its intent to ban mixed medical billings in the actual cost insurance system and introduce a reference price system for uncovered treatments. These measures were included in the Second National Health Insurance Comprehensive Plan (Draft), announced on Feb. 4, as well as in the task force’s first implementation plan on August 30.

The Second Comprehensive Plan outlined steps to enhance actual cost insurance, including prohibiting mixed medical billings, refining aesthetic medical care, and improving overall management. Additionally, the uncovered treatment management plan proposed reevaluating existing benefit items every two years and strengthening the system for selective benefits to establish a robust mechanism for their withdrawal.

The task force's first action plan provided more specific details. Regarding the prohibition of mixed medical billings, it stated: “For non-critical, uncovered treatment items prone to abuse, such as manual therapy, we will consider prohibiting mixed billings. This would limit the inclusion of health insurance benefits when medical necessity is low.”

The plan also aims to create a system for appropriately managing the volume and quality of medical treatments. For instance, it proposes involving medical institutions in setting criteria for uncovered treatments and determining pricing structures for actual cost insurance, as well as establishing a screening mechanism.

To enhance the management of uninsured treatments, the government plans to expand access to information on these treatments. It will introduce a reporting system and conduct surveys to provide consumers with details such as itemized prices, total treatment costs, efficacy and safety evaluations, and alternative reimbursed treatments. Additionally, it will promote the development of an integrated portal for consumers to easily access all relevant information on non-reimbursed treatments.

The government also aims to standardize the classification of non-benefit treatments by creating unified names and treatment standards. It plans to introduce appropriate pricing by announcing reference prices based on market or reimbursed prices for non-reimbursed items with significant price disparities, in consultation with the medical community.

In efforts to establish a management system for the beauty market, the government is considering creating classification standards to differentiate between medical beauty care provided by doctors and non-medical beauty services. It also seeks to refine the classification of medical and beauty devices based on these standards.

Despite these efforts, the government’s proposed ban on mixed medical billings and introduction of reference pricing are expected to exacerbate conflicts with the medical community.

“Based on the government’s announcements, it appears that the ban on mixed billings will be implemented, even if only partially,” a medical industry official told the Korea Biomedical Review. “The medical community strongly opposes this ban, and the plan could further escalate tensions.”

The official added that while concrete restrictions are yet to be finalized, even mentioning the ban has already had a significant impact.