75% of Non-Covered Care Spending Concentrated at Clinics and Hospitals... "A Black Hole for Essential-Care Personnel"

Kim Yoon: Top 20% of clinics account for 81% of all non-covered care expenses
56% of care lacks sufficient evidence or is not recommended... 69% of the public says, "The government should regulate it"

More than 75% of non-covered medical expenses were incurred at clinics and hospitals, with costs concentrated in these types of medical institutions. Concerns have been raised that the high profitability of the non-covered care market could draw medical professionals away from essential care and into other fields, underscoring the need for a management system that covers prices, volume of care and medical evidence.

On October 27, Assemblyman Kim Yoon of the Democratic Party of Korea published a 2026 parliamentary audit policy report titled "A Distorted Non-Covered Care Market, Essential Care in Decline." The report analyzes non-covered care data reported to the National Health Insurance Service and National Health Insurance medical expenses, and presents structural problems in the non-covered care market along with proposals for institutional reform.

According to the report, non-covered medical expenses totaled approximately 1.0445 trillion won in March 2025. Clinics accounted for 46.9% of the total, and hospitals for 28.4%. Combined, the two types of institutions incurred 787.4 billion won in non-covered medical expenses per month, equivalent to approximately 9.4484 trillion won annually.

Non-covered medical expenses were concentrated in a subset of medical institutions. Of the 28,770 clinics nationwide, the 5,754 clinics in the top 20% for non-covered medical expenses accounted for 80.5% of all non-covered expenses at clinics. Among hospitals, too, the top 20% of institutions accounted for 61.1% of total non-covered expenses.

The share of total medical expenses accounted for by non-covered care, referred to as "dependence on non-covered care," was also high at hospitals and clinics. It stood at 25.0% for hospitals and 18.6% for clinics, approximately five times and four times the rate, respectively, at tertiary general hospitals (4.7%). A total of 1,597 clinics and 146 hospitals relied on non-covered care for more than half of their total medical expenses.

The higher the price of non-covered care, the greater the tendency for an institution to depend on it. Clinics in the top 10% for manual therapy prices had an average dependence rate of 51.7%, about 2.5 times the 20.4% rate among clinics in the bottom 10%. For extracorporeal shock wave therapy, the dependence rate at clinics in the top 10% by price was 45.8%, about 2.8 times the 16.2% rate at clinics in the bottom 10%.

An analysis linking the results of medical technology reassessments by the National Evidence-based Healthcare Collaborating Agency (NECA) with actual treatment data found that, among approximately 380.2 billion won in non-covered care for which recommendation levels could be identified, 56.2% involved care with a mismatch in indications, insufficient evidence, a deferred recommendation or a recommendation against use. Non-covered care explicitly assessed as "not recommended" totaled approximately 38 billion won in March 2025 alone, equivalent to about 456 billion won annually.

A "balloon effect," in which demand shifts to other treatments when only certain non-covered services are regulated, was also observed. After manual therapy was brought under the managed-benefit system, the number of manual therapy claims submitted to five indemnity insurers fell by 92%, while the claimed amount dropped by 96%. By contrast, claims for spray-and-stretch therapy rose by 53%, and claims for related non-covered physical therapy increased by 41%. Some medical institutions also raised prices for other non-covered services, including ligament-strengthening injections, spray-and-stretch therapy and extracorporeal shock wave therapy.

The distribution of workplaces for newly qualified specialists also shifted as the non-covered care market expanded. Of the 2,126 new specialists in January 2024, 1,074, or 50.5%, worked at tertiary general hospitals. By January 2026, the figure had fallen to 149 of 417, or 35.7%. Over the same period, the share working at clinics rose by 11.3 percentage points, from 17.0% to 28.3%.

Assemblyman Kim proposed that the government manage the prices and volume of non-covered care and strengthen reassessments of medical technologies that lack sufficient evidence. He also said that linking the medical expense claims and review systems for National Health Insurance and indemnity insurance would help reduce gaps in oversight.

A survey commissioned by Assemblyman Kim from polling firm Jo Won C&I, which polled 1,000 adults nationwide from October 24 to 26, 2025, found that 68.5% said the government should manage non-covered medical expenses. A further 24.5% opposed government management, while 7.0% said they did not know.

"We must reduce the factors that push medical professionals out of essential care while also managing the economic incentives that draw them excessively into the non-covered care market," Assemblyman Kim said. "We need to systematically manage prices, volume of care and medical evidence, and link the review systems for National Health Insurance and indemnity insurance so that our limited medical workforce and resources can be allocated more appropriately to severe and essential care."

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