Reducing Excessive CT and MRI Tests by 2.6 Trillion Won to Strengthen Regional and Essential Healthcare

Ministry of Health and Welfare to Curb Overcompensation and Focus Increases on Undercompensated Services
Complete Overhaul of Specimen Test Consignment System After 27 Years

The government plans to restructure the health insurance spending model, which is currently concentrated on blood tests, computed tomography (CT), and magnetic resonance imaging (MRI), in order to reduce annual expenditures by 2.6 trillion won. The savings will be reinvested into essential medical services such as emergency and critical care, childbirth, and pediatrics. Additionally, 3.6 trillion won from the health insurance budget will be allocated annually to strengthen regional and essential healthcare, including the application of 'regional preferential reimbursement rates' to vulnerable areas both outside and within the Seoul metropolitan area.

The Ministry of Health and Welfare announced on June 25, during the 12th Health Insurance Policy Deliberation Committee, that it has finalized the "Plan for Structural Reform of Health Insurance Reimbursement Rates" reflecting these measures. The core of this reform is to fundamentally overhaul the existing reimbursement system, which has encouraged test-centric medical practices and failed to adequately compensate essential services such as consultations, hospitalizations, and major surgeries.

According to the government's analysis of medical expenses, the profit margin for specimen tests such as blood tests reached 190%, and for special imaging tests such as CT and MRI, it was 194%. In contrast, consultations, hospitalizations, and anesthesia were found to have a low compensation structure, falling short of even covering costs. As a result, medical institutions have focused on test-based care, and patients have been exposed to brief consultations and unnecessary tests—a problem the Ministry of Health and Welfare determined has persisted.

Kwon Byung-gi, Director of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, explained, "Our goal is to normalize the unreasonable compensation structure that has led to the collapse of regional and essential healthcare, as well as distortions in the healthcare delivery system."

First, the Ministry will shorten the adjustment cycle for the relative value scale—which determines health insurance reimbursement rates—to two years, with plans to implement annual adjustments in the future. Through this process, the Ministry will pursue increases for undervalued items such as essential medical services, while freezing rates for overvalued items. In particular, expenditures for specimen tests and special imaging, which have been relatively overcompensated, will be significantly adjusted to secure 2.6 trillion won in funding, which will then be invested into undercompensated essential areas such as consultation and hospitalization fees.

The consignment system for specimen testing, which allows specimens to be sent to private testing agencies, will also undergo a complete overhaul for the first time in 27 years since its introduction in 1999. There have been ongoing concerns that the current reimbursement system provides excessive compensation compared to the actual cost of testing, resulting in an increase in unnecessary tests. The government plans to recalculate costs through an analysis of medical expenditures and rationally adjust the compensation structure for specimen testing.

The revision of the relative value scale—a key component of health insurance reimbursement—will also be accelerated. The adjustment cycle, previously conducted every 5 to 7 years, will be shortened to every two years, with the long-term goal of establishing an annual adjustment system.

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