1. Reasons for Amendment
Medical fees for traditional Korean medicine paid from motor vehicle insurance has been on the rise in recent times, and critics have been continuously pointing out that lack of clarity in motor vehicle insurance medical fee standards for herbal medicine packages and pharmacopuncture is leading to overtreatment. Accordingly, this Amendment prescribes general principles for herbal medicine packages and pharmacopuncture in the traditional Korean medicine sector (prohibition of formulation of herbal medicine packages in advance, use of aseptic/sterilized pharmacopuncture solutions, itemized statements for prescribed or formulated herbal medicine packages/pharmacopuncture newly inserted). It also adjusts the maximum length of a single prescription for herbal medicine packages in the traditional Korean medicine sector from 10 days to 7 days for patients with minor injuries, and otherwise improves the standards on motor vehicle insurance medical fees, thereby aiming to enhance the quality of traditional Korean medical services and facilitate the streamlining of the standards.
2. Major Provisions
○ Improve the prescription length of herbal medicine packages (attached Table 2)
- Adjust the maximum length of a single prescription from 10 days to 7 days for patients with minor injuries.
○ Improve the applicability of medical fees for herbal medicine packages (attached Table 3)
- Recognize herbal medicine packages prescribed to traffic accident patients only when prescribed/formulated separately depending on the severity of the patient's symptoms and illness.
- When the maximum prescription length for herbal medicine packages has been exceeded, recognize on a case-by-case basis if deemed necessary for treatment purposes by a doctor of traditional Korean medicine.
- Require medical institutions to complete an “Itemized Statement of Herbal Medicine Package Prescriptions and Formulations Covered Under Motor Vehicle Insurance” (attached Form 13) via the “Herbal Medicine Registration and Management System” and submit it to the Health Insurance Review and Assessment Service.
○ Newly insert an itemized statement of prescription and formulation for herbal medicine packages (attached Form 13)
- Newly insert an itemized statement form for prescriptions/formulations of traditional Korean herbal medicine packages in accordance with the amended Table 3.
‧ Name of medical institution, patient information (name, date of birth, accident registration number, date of treatment), treatment information (total days of administration, extraction type, injury/disease code), prescription/formulation information (pattern identification, name of herbal medicine package and efficacy classification, prescription details (composition, g)
○ Specify pharmacopuncture frequency (attached Table 2)
- For patients with sprains or other minor injuries, limit to every day in every day in week 1 after the injury, three times a week in weeks 2 and 3, twice a week in weeks 4 to 10, and up to once a week after week 10.
○ Prescribe general principles for pharmacopuncture (attached Table 3)
- Ensure safety by recognizing pharmacopuncture prescribed to traffic accident patients only when objectively verified aseptic/sterile pharmacopuncture solutions have been used, and record the area treated and the reasons for prescription, etc. in the medical chart.
- Require medical institutions to complete an “Itemized Statement of Pharmacopuncture Covered Under Motor Vehicle Insurance” via the “Pharmacopuncture Management System” and submit it to the Health Insurance Review and Assessment Service when prescribing pharmacopuncture to a traffic accident patient.
○ Newly insert an itemized statement of formulation for pharmacopuncture (attached Table 14)
- Newly insert an itemized statement of formulation for pharmacopuncture in accordance with the amended Table 3.
‧ Name of medical institution, formulation details (name of medical institution where the treatment was formulated and extracted, method of formulation, name of pharmacopuncture, efficacy classification, appearance, dosage form, total volume (ml), date applied), components (names of medicinal herbs, content (g/ml))
