[Regulatory Content]
- According to Article 10 of the Medical Care Benefits Act, the government is responsible for covering the cost of medical benefits from the fund as per presidential decree, and the amendment adjusts this arrangement.
*(Current) The medical care fund covers all costs except for outpatient fees of 1,000-2,000 KRW and pharmacy fees of 500 KRW.
*(Amendment) The fund will cover 92-96% of outpatient costs and 98% of pharmacy costs.
1. Reason for Proposal
To expand the coverage and improve the sustainability of the Medical Care Benefits system, the proposal aims to revise the outpatient and pharmacy co-payment system to be proportional to medical usage. Additionally, a maximum co-payment per visit will be set to alleviate the burden of high medical costs and expand coverage for vulnerable populations.
2. Key Contents
a. A regulatory provision is established to allow for differential co-payments for medical care costs based on necessity, as specified by the Ministry of Health and Welfare (Article 13, Paragraph 3 of the Draft).
b. The co-payment for outpatient and pharmacy medical care costs will be adjusted in proportion to the beneficiary’s medical usage. A maximum co-payment per visit will be set to alleviate the financial burden on beneficiaries,
while extending benefits such as exemption from co-payments for patients with severe dementia or schizophrenia (Annex 1).
