Out-of-pocket rate to increase to 90% for those exceeding 300 outpatient visits per year
The government is reorganizing the medical utilization system to improve the efficiency of health insurance finances. Starting soon, patients who receive more than 300 outpatient treatments in a single year will be required to pay 90% of their medical expenses out of pocket. This measure is intended to reduce unnecessary "medical shopping" and ensure that benefits reach patients who truly need them.
This policy was introduced to prevent cases of excessive hospital utilization. Since most general patients receive fewer than 300 treatments per year, the impact of this change is expected to be minimal. The government plans to use this system to manage health insurance finances more stably.
However, this standard does not apply to all patients. Severe patients suffering from cancer or rare, intractable diseases are exempt from this regulation. Furthermore, exceptions will be made in cases where medical treatment is recognized as medically necessary, in order to minimize the burden on patients.
Meanwhile, regional base hospitals are strengthening medical services for local residents despite these changes. Local medical centers, such as the Hongseong Medical Center, are building a track record by performing vital roles in areas essential to the local community, including infectious disease response, rehabilitation, and hospice care.
The government expects this policy to serve as an opportunity to prevent the waste of medical resources and enhance the sustainability of the health insurance system. Moving forward, the government intends to continuously supplement related systems to ensure that citizens can receive appropriate medical services when they need them.