Korea Expands Coverage for Ultrasound Reimbursement

On October 1, Korea’s National Health Insurance Corporation expanded its coverage to include ultrasound scans for patients suffering from one of the so-called “four major diseases”: cancer, heart disease, cerebrovascular diseases and rare or incurable diseases. Under the new scheme, more than half of all hospital fees prior to listing will be reimbursed.

The increase in coverage is part of a broader $7.8 billion healthcare plan announced by Korea’s Ministry of Health and Welfare in June 2013. According to the plan, Korea will expand coverage of essential services for the 1.6 million Koreans suffering from one of the “four major diseases.”

Essential services include diagnostics like MRIs and genetic testing, along with drug and surgical treatment. Following the rollout of ultrasound coverage this year, MRIs and anti-cancer drugs will be covered in 2014, surgery will be covered in 2015 and genetic testing will be covered in 2016. It is unclear just how much each procedure will be reimbursed, though Korea’s President Park Geun-hye has promised that patients will need to pay only 5 – 10 percent of the final cost for each procedure.

Other treatments will be partially covered under the expansion, including the use of ultrasonic scalpers and capsule endoscopy. These treatments are to be considered selective—as opposed to essential—medical services, and will not be reimbursed until 2016.

Meanwhile, ultrasounds newly eligible for reimbursement have been divided into 49 separate categories, based on the examination target. The cost of ultrasounds for conditions other than the “four major diseases” will remain unchanged.