S. Korea to tighten rules on frequent hospital visits to curb health insurance overuse

Patients who make excessive hospital visits may soon face significantly higher out-of-pocket costs, as the government moves to rein in what it sees as overuse of the national health insurance system.

Under a proposed revision to the enforcement decree of the National Health Insurance Act unveiled Friday by the Health Ministry, patients who exceed 300 outpatient visits per year will be required to pay 90 percent of medical costs for any additional visits. Exceptions will be allowed in unavoidable cases, as determined by the health minister.

The new threshold lowers the current cap of 365 visits, in a bid to curb an overuse of the country’s relatively affordable public health care system, such as duplicate consultations locally referred to as “medical shopping."

It comes as persistently high health care usage has become a key driver of the growing burden on the national health insurance fund.

According to OECD health statistics, Koreans visited outpatient clinics an average of 18 times per year in 2023, the highest among member countries and nearly three times the OECD average of 6.5 visits. Japan followed with 12.1 visits, while Turkey and the Netherlands recorded 11.4 and 10.1 visits, respectively.

National health insurance spending on outpatient care has more than doubled over the past decade, rising to 51.5 trillion won ($34.1 billion) in 2024 from 24.1 trillion won in 2015.

To support enforcement, the government plans to introduce a real-time monitoring system to track patients’ health care usage. The system will allow authorities to identify excessive use early and respond accordingly.

The ministry said it will gather public feedback on the proposal through May 4. If finalized, the real-time monitoring system will take effect on Dec. 24 this year, while stricter limits on outpatient visits will be applied from Jan. 1 next year.