Korean Medical Association Demands Withdrawal of Managed Benefit Policy
The Korean Medical Association (KMA) is demanding the government immediately withdraw its policy designating three medical procedures as managed benefit items, claiming the measure only benefits private health insurers.
The Ministry of Health and Welfare announced on January 9 that manual therapy, radiation hyperthermia, and percutaneous epidural neuroplasty—three non-covered medical procedures that had raised concerns about overutilization—would be designated as managed benefit items eligible for national health insurance coverage. Managed benefits are a preliminary category of health insurance coverage applied to medical procedures deemed to require appropriate utilization management for social benefits such as reducing public medical expenses.
The KMA held a press conference at the association's headquarters in Yongsan-gu, Seoul, on Wednesday, urging the government to "withdraw the managed benefit designation that undermines patients' right to treatment and physicians' right to practice."
"The government's establishment of managed benefits is judged to seriously violate the principle of statutory reservation," the association said in a statement.
Lee Tae-yeon, KMA vice president and chair of the Private Health Insurance Response Committee, criticized the policy, saying "the fundamental cause of increasing non-covered services lies in the low medical fee structure that has persisted for decades and delays in incorporating new medical technologies into insurance coverage."
"The government is misrepresenting this as solely the medical community's responsibility when it is an inevitable result of the government's irresponsible policy failures," Lee said.
The KMA is particularly concerned about the impact when managed benefits are combined with fifth-generation private health insurance products set to launch early next year. Lee cited manual therapy as an example of clear harm to patients.
If manual therapy currently priced at 100,000 won is designated as a managed benefit at 40,000 won, medical institutions would be unable to cover costs including physical therapists' wages, effectively eliminating the service from the market, Lee explained.
The greater irony, according to Lee, is that while the price of manual therapy would be cut in half, patient costs would nearly double. If the government's announced 95 percent patient copayment rate for selective benefits is applied, patient out-of-pocket costs would increase from the current 20,000 won to 36,100 won.
Of the remaining 3,900 won, national health insurance would cover 2,000 won, leaving private insurers responsible for only 1,900 won—a dramatic reduction from the current 80,000 won burden.
Lee Bong-geun, KMA insurance director, argued that the medical community opposes this policy "because clear harm to patients' health recovery is predicted."
"The establishment of managed benefits, which lacks legal basis and rationality, should be immediately withdrawn, and the non-covered service management policy should be reviewed from scratch," Lee said.
The KMA proposed a "preliminary designation system" as an alternative to managed benefits, calling for discussions with the medical community on measures for autonomous regulation within the current non-covered service framework.
"If the government continues to ignore such reasonable opinions from medical experts and pushes forward with the policy, we will have no choice but to seriously consider refusing to participate in related consultative bodies including the Non-Covered Service Management Policy Committee," the insurance director said. "We will review and proceed with strong legal responses including filing constitutional complaints."
Of the five items that were considered likely candidates for managed benefit designation in prior consultative body discussions, extracorporeal shock wave therapy was excluded. The government plans to revisit whether to designate speech therapy and extracorporeal shock wave therapy as managed benefits in the future.