Outpatient Clinic Fee Increase Rate Set at 1.6%... Health Insurance Coverage for Rare Disease Treatments Within 100 Days

Final Decision on Outpatient Clinic Conversion Index at the 12th Health Insurance Policy Deliberation Committee
Pilot Project for Expedited Registration of Rare Disease Treatments to Launch in the Second Half of the Year
Introduction of Integrated Fee System at Local Clinics
Establishing a Korean-Style Primary Doctor Model

The increase rate for next year’s outpatient clinic reimbursement fees (conversion index) has been set at 1.6%. The government plans to allocate a portion of the budget to essential medical care compensation and, at the same time, will launch a pilot project in the second half of the year to shorten the health insurance registration period for rare disease treatments from the current 240 days to approximately 100 days.

Additionally, to establish a "Korean-style primary care model" that strengthens prevention and health management centered around local clinics, an integrated fee system will be introduced that combines consultation, examination, and treatment into a single reimbursement structure.

On the 25th, Lee Hyun, Chairman of the 12th Health Insurance Policy Deliberation Committee (Vice Minister of Health and Welfare), is speaking. Ministry of Health and Welfare

The Ministry of Health and Welfare announced on the 25th that it held the "12th Health Insurance Policy Deliberation Committee" and approved the decision plan for the 2027 outpatient clinic reimbursement fees (conversion index), as well as discussed the implementation plan for the pilot project for expedited registration of rare disease treatments and amendments to the community-based primary care innovation pilot project.

At the meeting, the committee finalized the increase rate for the 2027 outpatient clinic reimbursement fee conversion index at 1.6%. Of this, 0.9% will be reflected in the conversion index increase (setting the 2027 outpatient clinic conversion index at 96.5 won), and 0.7% will be applied to the increase in the relative value score for services such as consultation fees. The government will allocate a portion of the budget required for the conversion index increase to be connected to the essential medical care compensation system.

Health Insurance Registration for Rare Disease Treatments to Be Shortened from 240 Days to 100 Days

The committee also decided to launch a pilot project in the second half of this year to expedite the health insurance coverage of rare disease treatments.

The eligible treatments are rare disease medications that have either been approved by the Ministry of Food and Drug Safety or are undergoing the approval process, and that are currently being registered in at least three of the following A8 countries: the United States, United Kingdom, Germany, France, Italy, Switzerland, Japan, and Canada. The government will comprehensively consider the availability of alternative treatments, disease severity, and financial impact to select the drugs for the pilot project.

For these selected drugs, the aim is to simplify certain procedures—such as the cost-effectiveness evaluation, in addition to the clinical usefulness assessment—and shorten the health insurance coverage period from the current 240 days to around 100 days. After insurance coverage is granted, actual treatment outcomes will be evaluated using claims and review data from the Health Insurance Review & Assessment Service, as well as clinical data from medical institutions. Based on the results of the pilot project, a full-scale implementation will also be pursued.

The Ministry of Health and Welfare stated, "Through the expedited registration system for rare disease treatments, we will continue to work to improve patient access to care and reduce medical costs."

Local Clinic-Centered 'Korean-Style Primary Doctor'... Integrated Fees Covering Consultation and Procedures

The "Community-Based Primary Care Innovation Pilot Project," which aims to establish a "Korean-style primary care model," will also proceed with a revised compensation system. The goal of this project is to move beyond a focus solely on treating specific diseases, and to strengthen prevention and health management. A multidisciplinary team—consisting of doctors, nurses, physical therapists, nutritionists, and social workers—will provide registered patients with education and counseling, health management, referrals to advanced hospitals, and connections to community care resources. The project will target individuals aged 50 and older who have a high need for integrated health management, with gradual expansion planned in the future.

This will introduce an integrated fee system that takes into account the patient’s health status (HCC risk level). Previously, the integrated fee system focused on education and counseling, but now it will be expanded to cover the entire scope of clinical services, including consultation, examination, and treatment. However, medical institutions may choose to maintain the existing fee-for-service model instead of adopting the integrated fee system. The government plans to provide incentives—such as additional support for the transition and expanded performance-based rewards—to clinics that opt for the integrated fee system, in order to facilitate the adoption of the new compensation structure.

Support will also be provided for the operation of multidisciplinary teams, strengthening the function of primary care, and differential compensation based on performance evaluation. Registered patients will only be responsible for their own share of the costs for consultation, examination, and treatment, regardless of the compensation method chosen by the medical institution, so there will be no additional financial burden.

The Ministry will publicly invite medical institutions to participate in the pilot project in July and August, and plans to officially launch the project as early as September after completing the selection process. The Ministry of Health and Welfare stated, "The community-based primary care innovation pilot project is designed to establish a primary care system focused on prevention and management, rather than simply treating illness," adding, "We will diligently carry out the pilot project so that people can access high-quality primary care where and when they need it."

Meanwhile, at the committee meeting on this day, new vice chairperson and subcommittee chairpersons were appointed for the latter half of the 9th term. Shin Hyunwoong, Senior Research Fellow at the Korea Institute for Health and Social Affairs, was appointed as vice chairperson for the latter half, and Ham Myungil, professor at Soonchunhyang University, was selected as subcommittee chairperson for the latter half.

This content was produced with the assistance of AI translation services.