Compensation for Over 1,600 Major Surgeries Expanded... Additional NHI Fees for Holidays, Nighttime, and Emergency Care

Ministry of Health and Welfare to Allocate 3.6 Trillion Won Annually to Regional and Essential Healthcare

Preferential Regional Fees to Be Applied in Non-Metropolitan and Medically Underserved Areas

900 Billion Won for Critical and Emergency Final Treatments, 300 Billion Won for Maternity and Pediatric Care

The government will completely overhaul the National Health Insurance (NHI) fee system, which has long been cited as the main cause of the collapse of regional and essential healthcare and the distortion of the healthcare delivery system. It will inject an additional 3.6 trillion won annually into regional and essential healthcare sectors. This is the largest structural reform since the introduction of the current relative value point fee system in 2001.

According to the "National Health Insurance Fee Structure Innovation Plan" finalized by the Ministry of Health and Welfare on June 25, preferential regional fees will be officially introduced in six medical districts designated as medically underserved areas outside the Seoul metropolitan region, as well as in Gyeonggi-do and Incheon.

All surgeries and procedures performed at general hospitals in these regions will receive a 10% increase in NHI fees, and an additional 10% will be paid for emergency surgeries conducted at night or on holidays. For example, after the reform, if a tertiary general hospital in Jeonbuk performs a nighttime aneurysmectomy on an emergency patient, the fee, which is currently 10.5 million won, will increase to as much as 17.02 million won with the application of the regional preferential rate.

The government also plans to support 84 cities and counties classified as depopulating areas by raising outpatient consultation fees by 5% at clinics and hospitals, and inpatient fees at hospitals by 5%, providing annual support of 400 billion won. Through these measures, the government aims to address the structural disadvantages faced by regional medical institutions compared to those in the metropolitan area, and to create a foundation that enables the treatment of severe patients in local regions as well.

Consultation fees will also be raised for the first time in 20 years. Initial consultations at neighborhood clinics will increase by 6%, and follow-up visits by 4%. For hospitals and higher-level institutions, both initial and follow-up consultations will increase by 2%. The in-depth consultation service, which has been operated as a pilot project at tertiary general hospitals and in certain pediatric fields, will be converted into a full-scale program and expanded to include general hospitals and primary care institutions such as internal medicine, family medicine, and obstetrics and gynecology.

Fees for more than 1,600 high-difficulty major surgeries and procedures for conditions such as cardiovascular disease, cancer, and acute abdominal emergencies will be raised by 20%. In particular, if an emergency patient receives surgery at night or on holidays through a regional emergency medical center, compensation will be expanded up to 5.5 times the previous level. Fees for anesthesia during final treatment processes, such as general anesthesia and anesthesia accompanying major surgeries, will also be increased by 50%, and the additional payments for night-time and holidays will be expanded. The government explained that it will focus compensation on the "final treatment" in emergency medicine to address the tendency to avoid performing actual surgeries and treatments even after admitting patients to the emergency room. This initiative will involve an investment of 900 billion won per year.

For advanced and regional maternal and neonatal centers specializing in the intensive care of high-risk mothers and newborns, additional fees will be applied to premature deliveries and treatments in neonatal intensive care units. Further preferential payments will be provided to maternal and child centers outside the Seoul metropolitan area to strengthen regional childbirth infrastructure. Additionally, fees for about 200 items related to pregnancy and childbirth will be raised by 20%, and high-risk deliveries will receive an extra preference of 100% to 200% over ordinary deliveries.

In pediatric care, the age for additional consultation fees will be expanded from children under six to those under eight, and new preferential payments will be introduced for complex pediatric surgeries. Support will also be expanded for interventions in pediatric intensive care units and for the Dalbit Children’s Hospital, thereby strengthening the pediatric care system from primary care to critical care.

The government will prioritize the enhancement of compensation for maternal and child centers from the third quarter of this year, with the remaining measures scheduled to take effect starting in December.

Minister of Health and Welfare Jeong Eun-kyeong emphasized, "The NHI fee innovation plan is the first step in significantly reinforcing investment in regional and essential healthcare to save lives," adding, "Starting with the largest-ever annual investment of 3.6 trillion won since the NHI fee reform, we will ensure that support from the Special Regional Essential Healthcare Fund is provided without fail."

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