🚨 Non-Covered Medical Expenses

Today Korean Social News for Beginners | 2025.09.04

0️⃣ Up to 20x Price Gap Revealed Through Medical Cost Disclosure and Healthcare Market Changes

📌 "Non-covered medical costs show up to 20x difference"…Price disclosure shakes healthcare market

💬 The Ministry of Health and Welfare and Health Insurance Review & Assessment Service have fully disclosed prices for non-covered medical services at hospitals nationwide. 693 items including physical therapy, MRI, and dental implants are covered, with price differences reaching up to 20 times, causing major waves in the healthcare market. While patients can now make informed choices, concerns arise that simple price comparisons could lead to quality deterioration and financial difficulties for smaller hospitals. This measure is seen as a policy tool to increase healthcare market transparency, but it may lead to discussions about reducing non-covered items or converting them to covered services in the long term. Changes in ophthalmology, dentistry, and rehabilitation fields, where demand is growing due to aging, are particularly noteworthy.

💡 Summary

• Non-covered medical expenses are medical services not covered by National Health Insurance, requiring full patient payment.
• Nationwide hospital prices for non-covered services were disclosed for the first time, revealing up to 20x price gaps.
• Healthcare market transparency is strengthened, but concerns about side effects from intense price competition also exist.

1️⃣ Definition

Non-covered medical expenses refer to medical services not covered by National Health Insurance, requiring patients to pay the full cost themselves. While covered services receive 70-90% support from the Health Insurance Corporation with patients paying only a portion, non-covered services must be paid 100% by patients.

Typical non-covered services include physical therapy, dental implants, LASIK/LASEK surgery, some MRI scans, vaccinations, and cosmetic procedures. Hospitals can set prices independently for these services, so the same treatment can cost very different amounts at different medical facilities.

💡 Why is this important?

• It's a key factor that greatly affects medical cost burden.
• It enables price comparison and rational consumption when choosing hospitals.
• It directly impacts healthcare market competition structure and service quality.
• It's closely related to health insurance finances and medical accessibility issues.

2️⃣ Current Status of Non-Covered Price Disclosure and Its Impact

📕 Nationwide Medical Institution Non-Covered Price Disclosure Details

• Prices for 693 non-covered items have been transparently disclosed. Key findings include:

  • Physical therapy showed a 20x difference, ranging from 20,000 won to 400,000 won per session.
  • Dental implants formed various price ranges from 400,000 won to 3 million won each.
  • MRI scans showed a 10x gap, ranging from 150,000 won to 1.5 million won by body part.
  • Health checkup packages showed very large variations from basic 100,000 won to premium 5 million won.

• Regional and hospital size-based price differences were also clear. Key characteristics include:

  • Large hospitals in Seoul's Gangnam area formed the highest price ranges nationwide.
  • Regional smaller hospitals are trying to secure competitiveness with relatively lower prices.
  • University and general hospitals maintain high prices while emphasizing advanced equipment and expertise.
  • Clinic-level medical facilities are attempting differentiation through accessibility and reasonable prices.

📕 Patient and Medical Community Reactions

• Patients generally show positive reactions to price transparency. Major changes include:

  • The number of patients comparing prices at multiple hospitals before treatment has greatly increased.
  • Price shopping phenomena appeared especially for expensive treatments like implants and LASIK surgery.
  • Active sharing of hospital price information in online communities has increased.
  • Medical service satisfaction is improving through guaranteed patient rights to information.

• The medical community shows both concerns and expectations simultaneously. Major reactions include:

  • Some hospitals worry that reckless price competition could lead to declining medical quality.
  • Smaller hospitals are concerned about worsening management and accelerated medical staff departure.
  • Conversely, reasonably priced hospitals are experiencing increased patient influx and sales growth.
  • The entire medical community faces pressure to improve service quality and efficiency.

💡 Key Issues in Non-Covered Price Disclosure

1. Price Transparency vs Quality Gap: Simple price comparison may distort medical service quality
2. Large Hospitals vs Small Hospitals: Competition structure favoring large hospitals with economies of scale
3. Patient Choice vs Accessibility: Low-price choices may lead to weakening regional medical infrastructure
4. Competition Promotion vs Medical Safety: Risk of excessive price competition reducing essential safety investments
5. Short-term Effects vs Long-term Policy: Need for fundamental solutions like benefit expansion or price regulation

3️⃣ Healthcare Market Changes and Policy Direction

✅ Changes in Healthcare Market Competition Structure

• Transformation to a patient-centered healthcare service market is underway. Major changes include:

  • Hospitals are pursuing operational efficiency to secure price competitiveness.
  • More investment is being made in developing differentiated services and improving patient satisfaction.
  • Quality competition including medical staff expertise and latest equipment introduction is also being strengthened.
  • Patient counseling and follow-up care services have emerged as important factors in hospital selection.

• New services linked to digital healthcare are also emerging. Major trends include:

  • Platforms enabling online reservation and price comparison are rapidly expanding.
  • Efforts to reduce costs through telemedicine and monitoring services continue.
  • AI diagnostic tools are being utilized to pursue shortened treatment times and improved accuracy.
  • Patient data-based personalized treatment planning is spreading.

✅ Government Policy Direction and Long-term Outlook

• Strengthening non-covered management and expanding covered services policies are being pursued. Main directions include:

  • Plans to reduce patient burden through converting essential medical items to covered services are under review.
  • Non-covered price caps or standardization measures are also being discussed long-term.
  • Introduction of differential fee systems linked to medical institution quality evaluation is being considered.
  • Health insurance financial stabilization and benefit enhancement are being pursued simultaneously.

• Balanced regional medical development and accessibility assurance are also important tasks. Major measures include:

  • Plans to maintain regional medical infrastructure through supporting regional smaller hospitals are being prepared.
  • Accessibility is being improved through expanded public investment in essential medical fields.
  • Policies to encourage regional work through medical staff incentive systems are being strengthened.
  • Reducing regional medical gaps through expanded telemedicine is being promoted.

4️⃣ Related Terms Explanation

🔎 National Health Insurance Act

• The National Health Insurance Act is the basic law that distinguishes between covered and non-covered medical services.
  • The National Health Insurance Act is a social insurance-related law aimed at contributing to improving national health and promoting social security by providing insurance benefits for disease and injury prevention, diagnosis, treatment, rehabilitation, childbirth, death, and health promotion.
  • Under this law, covered items are divided into medical benefits, medical expenses, health screenings, vaccinations, etc., with insurance benefits applied according to government-set standards. Covered items limit patient co-payment rates to 20-30%, greatly reducing patients' medical cost burden.
  • Conversely, non-covered items are medical services not recognized as benefits under the law, requiring patients to bear the full cost. Typical examples include cosmetic procedures, experimental new medical technologies, and premium room fees. The government introduced a price disclosure system to increase transparency of non-covered items and encourage reasonable price formation.

🔎 Selective Medical Care System

• The selective medical care system was a past system where patients paid additional costs to receive treatment from specific doctors.
  • The selective medical care system, introduced in 1989, allowed patients to designate specific doctors (mainly professors) for treatment while bearing additional costs. This aimed to increase medical staff income and guarantee patient choice rights, but was criticized for deepening medical gaps between social classes.
  • Several problems emerged during system operation. First, excessive selective medical fees limited medical accessibility for the working class. Second, discrimination occurred with different treatment by doctors within the same hospital. Third, patients were forced to choose selective care despite financial burden due to concerns that treatment would be delayed otherwise.
  • Eventually, the selective medical care system was completely abolished in March 2018, with most treatments converted to covered items. This became a representative case of non-covered item reduction and set a precedent for potential benefit expansion discussions for other high-cost non-covered treatments.

🔎 New Medical Technology Assessment System

• The new medical technology assessment system systematically evaluates the safety and effectiveness of new diagnostic and treatment technologies.
  • The new medical technology assessment system systematically evaluates safety and effectiveness before newly developed medical technologies receive National Health Insurance benefit coverage. It is overseen by the National Evidence-based Healthcare Collaborating Agency (NECA), with medical and academic experts participating in evidence-based evaluations.
  • The evaluation process occurs in stages. First, the safety of submitted technologies is primarily reviewed. Second, effectiveness and economic efficiency compared to existing treatments are analyzed. Third, domestic and international clinical data and research results are comprehensively reviewed. Fourth, expert committees make final determinations.
  • Technologies that fail evaluation are not recognized as covered items and are classified as non-covered. This causes many new technology treatments to initially operate as expensive non-covered services, increasing patients' economic burden. However, benefit conversion is reviewed after sufficient evidence accumulates, gradually improving medical accessibility.

5️⃣ Frequently Asked Questions (FAQ)

Q: What benefits can I receive when non-covered prices are disclosed?

A: Rational medical consumption and hospital selection become possible, with expected medical cost savings.

• The main benefits from price disclosure are as follows. First, you can reduce economic burden by checking price differences between hospitals for the same treatment in advance. For physical therapy, there are differences from 20,000 won to 400,000 won per session depending on the hospital, so you can choose according to your economic situation. Second, you can receive better medical services by comparing service quality relative to price. Third, as competition between hospitals intensifies, overall price reductions and service quality improvements can be expected. Fourth, medical satisfaction increases as you can make decisions based on sufficient information before treatment.
• However, rather than simply choosing the cheapest option, it's important to comprehensively consider medical staff expertise, equipment quality, and follow-up care services when making choices.

Q: Is there a possibility that non-covered items will be converted to covered services in the future?

A: Gradual conversion of some items is expected according to government policy direction and social necessity.

• There are areas with high potential for benefit conversion. First, items with clear treatment purposes and sufficient medical evidence are priority review targets. For example, some MRI scans or specific treatments could be applicable. Second, items essential for national health but with poor accessibility due to economic burden are also considered. Third, discussions about converting treatments for geriatric diseases in preparation for an aging society are active. Fourth, items that become policy improvement targets from a social equity perspective, like the selective medical care system abolition case, could be subject to policy improvement.
• However, there are also limiting factors for benefit conversion. Concerns about increased health insurance financial burden, worsening medical institution profitability, and surging medical utilization require careful approaches. Therefore, gradual and selective benefit expansion appears to be the realistic direction.

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