South Korea is pushing to raise the patient copayment rate to 90% for individuals who make more than 300 outpatient visits annually, as the government moves to rein in health insurance spending.
The Ministry of Health and Welfare confirmed the 2026 implementation plan for the "2nd National Health Insurance Comprehensive Plan (2024-2028)" at the Health Insurance Policy Deliberation Committee meeting on Sunday. The current 90% copayment threshold of 365 annual visits will be tightened to 300 visits, with the change set to take effect in the second half of 2026 following revision of enforcement decrees.
The measure comes amid rapidly deteriorating health insurance finances. The National Health Insurance's current account balance plunged 88% in two years, from 4.1 trillion won in 2023 to 499.6 billion won in 2025. The government believes fiscal sustainability could be undermined without curbing unnecessary medical treatments as spending pressures mount from an aging population and increased healthcare utilization.
The insurance premium calculation method for regional subscribers will also shift from a tiered system to a proportional rate system, so premiums rise in proportion to increases in property value. The change aims to correct a structure where individuals with similar assets paid different premiums due to bracket differences. The government plans to form a dedicated task force to develop the reform proposal.
"The National Health Insurance Act must be amended to collect premiums on a proportional rate basis," a ministry official said. "We are targeting legislative revision by the second half of this year."
A post-management system for medical procedures will also be launched in earnest. A "Medical Procedure Reevaluation and Reclassification Task Force" will be established under the deliberation committee to review safety and efficacy changes across approximately 7,760 registered medical procedures. The initiative aims to lower fees for overcompensated procedures while raising reimbursement rates for undercompensated essential medical services.
The ministry plans to form the task force as early as the first quarter for permanent operation. While the National Evidence-based Healthcare Collaborating Agency has reevaluated about 300 medical procedures, linkage to the compensation system has been limited.
The task force will consider reducing or excluding coverage for procedures with relatively low difficulty or limited clinical necessity, while reclassifying essential medical procedures that are undercompensated relative to their complexity to bring fees in line with reality.
"Through medical procedure reevaluation, 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 copayment).
Meanwhile, the Korea Disease Control and Prevention Agency announced the "3rd National Antimicrobial Resistance Management Plan (2026-2030)" jointly with related ministries, pledging to gradually expand "antimicrobial stewardship programs" to reduce antibiotic misuse. Under the program, infectious disease specialists and pharmacists will review prescriptions. The initiative will be applied to 170 general hospitals with 301 beds or more by 2027, with institutionalization planned for 2028.