As Many as 1,775 Outpatient Visits a Year: "Hospital Shopping"... Now 90% Copayment for Over 300 Visits

Exemptions for Children, Pregnant Women, and Patients with Severe or Rare Diseases
CT and MRI Treatment Records Accessible Starting in December

Starting next year, if an individual receives more than 300 outpatient treatments annually, the out-of-pocket health insurance contribution rate will be increased to 90% for any additional treatments beyond that threshold. However, patients who medically require frequent treatments, such as children, pregnant women, and those with severe, rare, or hard-to-cure diseases, will be exempted from this measure.

The Ministry of Health and Welfare announced on September 8 that the partial amendment to the Enforcement Decree of the National Health Insurance Act, which contains these details, was approved at a Cabinet meeting. This amendment is focused on managing excessive outpatient use, establishing a system to verify medical usage records, and reducing the burden on both subscribers and employers during insurance contribution settlements.

According to the amendment, starting January 1 of next year, if the annual number of outpatient treatments exceeds 300, a 90% personal contribution rate will be applied starting from the 301st visit. An annual total of 300 outpatient visits is equivalent to approximately six visits per week to medical institutions.

Currently, the threshold is set at over 365 visits per year. Although the government has lowered this standard to 300, the protection measures for patients who are medically required to receive frequent outpatient treatments will remain unchanged. As a result, children, pregnant women, those with disabilities who are eligible for special calculation exceptions, and patients receiving treatment for severe, rare, or hard-to-cure illnesses will be exempted. Other patients may also be granted exceptions if the Medical Overutilization Review Committee of the National Health Insurance Service determines medical necessity following a review.

The government decided to strengthen management of outpatient treatment use because it has judged that medical service usage in Korea is excessive. In 2024, the annual number of outpatient visits per capita in Korea was 17.9, which is about 2.7 times higher than the OECD average of 6.6.

According to the Ministry of Health and Welfare, of the approximately 48.4 million outpatient treatment users in 2025, 7,765 people received more than 300 outpatient treatments annually. Their average number of outpatient visits per year was 344.7, and there was even a case in which an individual used outpatient services 1,775 times in one year. The government explained that excessively frequent treatments can result in repeated or similar tests and treatments, which could threaten patient safety and hinder the efficient use of limited medical resources.

Easier Review of Medical History... Lower Thresholds for Installment Insurance Premium Payments

A system for confirming patients' usage records at other medical institutions, called the Healthcare Service Utilization Verification System, will also be established. Beginning December 24, the system will first allow verification of computed tomography (CT) and magnetic resonance imaging (MRI) usage records, and will later expand to other areas. This system will be linked with electronic medical records (EMRs) to enable medical staff to easily check required usage records when prescribing, and the Health Insurance Review and Assessment Service will be entrusted with its establishment and operation.

The standards that allow workplace health insurance beneficiaries to pay additional insurance premiums—required due to year-end tax settlement, for example—in up to 12 installments will be significantly lowered. Currently, installment payments are only possible if the additional premium is greater than or equal to the beneficiary's monthly personal contribution, but starting next month, an application can be made if the additional premium is greater than or equal to the minimum monthly wage-based contribution for workplace subscribers. As of 2026, this means an additional premium of 10,080 won (KRW) or more is eligible for installment payment.

The deadline for businesses to submit their year-end settlement data will also be extended from March 10 to March 31 every year. As more businesses will be able to reconcile insurance premiums by linking with National Tax Service data, the Ministry of Health and Welfare expects this to reduce the reporting burden for businesses regarding total wage declarations.

In addition, the management system for reimbursed and non-reimbursed items will be overhauled in line with advances in medical technology. The amendment clarifies grounds that allow the Minister of Health and Welfare to review or adjust medical services and treatment materials previously classified as reimbursed or non-reimbursed if there are changes in safety, efficacy, cost-effectiveness, or reimbursement appropriateness. The law will also stipulate that pharmaceuticals approved for itemization or notified under the Pharmaceutical Affairs Act, but not designated for reimbursement, will be classified as non-reimbursed items.

This amendment will generally take effect on October 1, except for provisions regarding the Healthcare Service Utilization Verification System, which will be enforced starting December 24, and the changes to outpatient visit thresholds, which will be enforced from January 1 of next year.

Yoo Juheon, Director of Health Insurance Policy at the Ministry of Health and Welfare, said, "This amendment aims to sufficiently guarantee medically necessary treatments while reducing patient safety risks related to repetitive or excessive usage, and to help citizens use medical services more appropriately. We will also lower the one-time payment burden during insurance settlement and the reporting requirements for businesses, so the public can directly experience the benefits of these changes. We will ensure there are no disruptions as we implement them."

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