Government boosts compesation for high-difficulty head and neck surgeries

Starting in September, compensation for “highly difficult head and neck surgeries” will increase, with the government allocating up to 5.5 billion won ($3.9 million) from the health insurance fund.

The Ministry of Health and Welfare approved the “Plan to Strengthen Compensation for Highly Difficult Head and Neck Surgeries” at the Health Insurance Policy Review Committee meeting on Thursday.

Head and neck cancer surgery is considered a representative field that is avoided due to its high difficulty, given the characteristics of the face and neck areas and the presence of many adjacent organs, while being relatively undervalued. According to the ministry, among the seven regional emergency medical centers in Seoul, only Seoul National University Hospital has a full-time head and neck surgeon among its staff.

In response, the ministry has decided to increase the relative value scores for 29 head and neck-related surgical procedures, including oral cavity tumor resection and laryngeal cancer surgery, to strengthen compensation by reflecting the characteristics and difficulty of head and neck surgery.

As a result, the fees for 24 head and neck cancer-related surgeries, including oral tumor resection, laryngectomy, and hypopharyngeal resection, will be increased by 20 percent to a maximum of 80 percent. At tertiary hospitals, the current fee for oral and pharyngeal malignant tumor surgery is approximately 920,000 won, but it will be increased by 80 percent to 1.66 million won after the improvement.

Additionally, compensation will be strengthened by revising reimbursement standards to reflect the manpower and time required for surgeries in adjacent areas when head and neck cancer surgeries necessitate simultaneous procedures due to adjacent area involvement. For tongue cancer at tertiary hospitals, when the entire tongue is resected due to invasion of the oral floor, the current reimbursement is approximately 2.65 million won, recognizing only tongue cancer surgery. Following the improvement, tongue cancer surgery and oral malignant tumor excision will be recognized as primary and secondary surgeries, resulting in an increase in reimbursement to approximately 5.15 million won, nearly double the current amount.

Besides, considering the difficulty and severity of head and neck surgeries, such as laryngeal abscess incision (cervical), the fees for five head and neck surgeries will be increased by 15 percent to a maximum of 55 percent.

Furthermore, to address the issue that there are no fees reflecting the difficulty of reconstructive surgery for defects occurring after head and neck cancer surgery, a new fee for “perforator-based free flap (skin graft) surgery” will be established. For facial perforator flap procedures performed at tertiary hospitals, the current fee for facial free flap surgery is approximately 2.93 million won; however, this will increase by 30 percent to 3.81 million won after the revision.

The ministry estimates that the fee increase will require an additional 4.7 billion won to 5.5 billion won in annual funding. The fee increase will take effect in September following the revision of relevant regulations.

“We are continuing to strengthen compensation for essential medical fields that have been undercompensated due to inadequate reflection of surgical difficulty or characteristics,” the ministry said. “This compensation enhancement for high-difficulty head and neck surgeries and reconstructive surgeries following such procedures will contribute to maintaining the infrastructure for rare surgical fields.”