South Korea will raise the patient cost-sharing rate to 90% for individuals who make more than 300 outpatient visits annually, as the government moves to shore up the nation's strained health insurance finances.
The Ministry of Health and Welfare confirmed the measure at a Health Insurance Policy Deliberation Committee meeting on the 25th, as part of the 2026 implementation plan for the Second National Health Insurance Comprehensive Plan (2024-2028). The current threshold of 365 visits will be tightened to 300, with the change taking effect in the second half of 2026 following revisions to the enforcement decree.
The policy shift comes amid rapidly deteriorating health insurance finances. The National Health Insurance's current account balance plunged 88% from 4.1 trillion won in 2023 to 499.6 billion won in 2025. The government warns that without curbing unnecessary medical visits, fiscal sustainability could be at risk as spending pressures mount from an aging population and rising healthcare utilization.
The government will also overhaul how insurance premiums are calculated for regional subscribers by switching property-based premiums from a tiered system to a proportional rate structure. This aims to correct situations where individuals with similar assets paid different premiums due to bracket differences. A dedicated task force will develop the reform plan.
"The National Health Insurance Act must be amended to collect premiums on a proportional basis," a Ministry official said. "We are targeting legislative revision by the second half of this year."
A new post-management system for medical procedures will also take shape. A "Medical Procedure Re-evaluation and Reclassification Task Force" will be established under the deliberation committee to review the safety and efficacy of approximately 7,760 registered medical procedures. The body will work to lower fees for over-compensated services while raising rates for under-compensated essential care.
The Ministry plans to launch the task force as early as the first quarter for permanent operation. While the National Evidence-based Healthcare Collaborating Agency has re-evaluated about 300 medical procedures, linkage with the compensation system has been limited. The task force will review reducing or excluding coverage for procedures of relatively low difficulty or limited clinical necessity, while reclassifying essential medical procedures that are under-compensated relative to their complexity.
"Through medical procedure re-evaluation, we will adjust compensation levels or exclude from coverage cases where procedures have been replaced by new technologies or where safety and efficacy have changed," a Ministry official emphasized.
The committee also approved expanding health insurance coverage for the immunotherapy drug Imfinzi (durvalumab) from non-small cell lung cancer to include bile duct cancer. Starting next month, annual medication costs for bile duct cancer patients are expected to drop dramatically from approximately 118.93 million won to 5.95 million won (5% patient copay).
Separately, the Korea Disease Control and Prevention Agency announced the "Third National Antimicrobial Resistance Management Plan (2026-2030)" in coordination with related ministries. The agency will gradually expand "antimicrobial stewardship programs" to reduce antibiotic misuse. Under the system, infectious disease specialists and pharmacists will review prescriptions, with implementation at 170 general hospitals with 301 or more beds by 2027, followed by institutionalization in 2028.