A new plan in South Korea proposes increasing the personal cost responsibility rate for outpatient treatments exceeding 300 visits annually to 90%, while also expanding health insurance coverage for immunotherapies for bile duct cancer.
On October 25th, the South Korean Ministry of Health and Welfare held a meeting to review and confirm the 2026 implementation plan for the 'Second Comprehensive National Health Insurance Plan (2024-2028)'. One significant change proposed is adjusting the limit for outpatient treatments from the current threshold of 365 visits per year to 300 visits. This shift aims to enhance the financial sustainability of the health insurance system by reducing excessive medical use and expanding the scope of personal cost responsibility. The implementation of this plan is expected to begin in the second half of this year following amendments to the National Health Insurance Act Enforcement Ordinance.
Additionally, the health insurance contributions for local enrollees will change from a tiered system based on asset levels to a proportional system that reflects both income and assets. Since September 2022, a proportional contribution method has primarily been applied to income. Furthermore, to reduce the financial burden of hospitalization support, the plan includes efforts to lower the current full responsibility for certain nursing care fees in long-term care hospitals to around 30%. There are also proposed improvements to the integrated nursing and care services by gradually easing restrictions on access to advanced general hospitals.
In a related development, the health insurance coverage for the immunotherapy drug, 'Imfinzi' (ingredient name: durvalumab), will be expanded to include bile duct cancer starting March 1. This expansion is expected to drastically reduce the annual treatment costs per bile duct cancer patient from approximately 118.93 million KRW to about 5.95 million KRW, significantly alleviating the financial burden for patients fighting this aggressive cancer.
