The government will increase the fees for cerebrovascular and abdominal aortic aneurysm surgery from January next year to compensate for high-risk and difficult essential medical care. The cost of surgery increases by up to 2.7 times by subdividing the difficulty of the surgery, such as the surgical site and whether the blood vessel is ruptured. In addition, out-of-pocket expenses for the first mental health test within the national health checkup will be supported and rare diseases subject to special calculations will be expanded.
Park Min-soo, Second Vice Minister of Health and Welfare, is speaking at the 19th Health Insurance Policy Deliberation Committee of 2024 held at the International Electronics Center in Seocho-gu, Seoul on the 26th. Photo: Ministry of Health and Welfare
On the afternoon of the 28th, the Ministry of Health and Welfare held the 23rd Health Insurance Policy Deliberation Committee (Geonjeongsim) in 2024 and decided on ‘Measures to improve the cost of cerebrovascular and abdominal aortic aneurysm surgery.’ Cerebrovascular-related surgeries such as craniotomy (surgery to make an incision in the skull) and tracheotomy (surgery to make a hole in the head) are emergency surgeries, and abdominal aneurysm surgery is a surgery that has the possibility of death if the abnormally dilated abdominal aorta ruptures. . These are all essential medical fields that are directly related to life and are considered fields to be avoided.
Starting from January next year, the prices for cerebrovascular surgeries such as craniotomy and tracheotomy and abdominal aneurysm surgery will increase by up to 2.7 times. Specifically, the surgery is subdivided considering whether the blood vessel is ruptured, whether it is accompanied by a lobotomy, and the surgical site. Accordingly, the level of risk and difficulty is classified and a relative value score of up to 2.7 times is assigned. An official from the Ministry of Health and Welfare explained, “By strengthening compensation for high-risk and difficult medical practices, we will be able to contribute to maintaining infrastructure such as manpower in essential medical fields and eliminating blind spots in treatment.”
If the mental health test within the national health checkup shows that you are at risk for depression or early psychosis, out-of-pocket expenses for your first treatment will also be supported from January of next year. This is to lower the burden of psychiatric treatment costs. Items included in the first treatment cost support are consultation fees, testing fees (1 type of symptom and behavior evaluation scale test), and counseling fees (1 type of individual psychotherapy).
Currently, health check-ups include depression tests, but the rate leading to treatment is low. People aged 20 to 34 are tested once every two years, and other age groups are tested once every ten years, but only 17.8% of those at risk for mental health were treated. The government hopes to detect mental illness early, start treatment, and prevent it from becoming chronic by supporting the cost of the first mental health examination.
66 diseases, including achalasia, which has been newly designated as a rare disease subject to national management, are included in special cases for health insurance calculation. Achalasia is a condition in which food cannot pass down due to a problem in the esophagus. According to the special system for calculating out-of-pocket expenses in health insurance, patients with serious diseases such as cancer, who have a large medical cost burden, and rare and severe incurable diseases are subject to a co-payment rate of 0% to 10% for both hospitalization and outpatient treatment when special calculation methods are applied. Typically, the health insurance out-of-pocket rate is 20% for hospitalization and 30-60% for outpatients.
In addition, it was decided to cover Camgios (main ingredient: mavacamten), a treatment for improving motor function and symptoms of patients with obstructive hypertrophic cardiomyopathy, through health insurance. To relieve the patient’s symptoms, the use of treatments (beta blockers, calcium channel blockers) used for high blood pressure and arrhythmia was recommended. However, it was either ineffective or had severe side effects. According to this resolution, the cost of Kamzios medication, which is about 22.49 million won per person per year, is expected to be reduced by about 2.25 million won (when applying the 10% special exception for calculating out-of-pocket expenses), thereby expanding opportunities for patient treatment.
Reporter Moon Sanghyeok [email protected]
