In a move that signals a paradigm shift in South Korea’s healthcare market, the government has announced a sweeping regulatory crackdown on non-reimbursable medical services. The primary target of this first-of-its-kind intervention is manual therapy (chiro-practice), a sector estimated to be worth approximately 1.5 trillion won annually.

The Ministry of Health and Welfare (MOHW) revealed on Thursday that it plans to reclassify manual therapy as a "Management Benefit" (Gwanri-Geubyeo) starting July 1, 2023. This new category acts as a hybrid between National Health Insurance (NHI) coverage and non-reimbursable services, granting the government the authority to directly control pricing and usage guidelines—powers it previously lacked over the private pricing models of clinics.

Drastic Price Cuts and Strict Frequency Caps

Currently, the price for a single session of manual therapy is determined autonomously by each medical institution. In primary care clinics, the average cost hovers around 110,000 won per session. However, the MOHW is reviewing a plan to set a standardized price of approximately 40,000 to 43,000 won for a 30-minute session. This represents a more than 50% reduction from current market rates.

The final price is expected to be confirmed later this month following a meeting of the Health Insurance Policy Advisory Committee. Under the "Management Benefit" system, patients will be responsible for 95% of the cost, while the NHI will cover the remaining 5%. Despite the small insurance contribution, the real impact lies in the government-mandated price ceiling.

In addition to price controls, the government is introducing strict limits on the frequency of treatment. General patients will be restricted to two sessions per week, with an annual cap of 15 sessions. For patients requiring post-surgical rehabilitation, an additional nine sessions may be granted, allowing for a maximum of 24 sessions per year. Any treatment exceeding these limits will be classified as "Unauthorized Non-reimbursable" (Imui-Bigeubyeo), meaning neither the patient nor the insurance provider will recognize the cost.

Combating Over-treatment and Strengthening Essential Care

The government maintains that these measures are essential to curb "over-treatment" and "moral hazard." For years, critics have pointed out that some clinics check a patient's private indemnity insurance status before recommending expensive, long-term manual therapy sessions that may not be medically necessary. Financial authorities have reported a sharp spike in insurance payouts related to manual therapy, which has been a major driver of rising private insurance premiums for the general public.

Furthermore, the government views the lucrative non-reimbursable market as a primary cause of the labor shortage in "essential medical fields" such as emergency care, pediatrics, and obstetrics. By making non-reimbursable services like manual therapy less profitable, the government hopes to discourage medical professionals from flocking to aesthetic and musculoskeletal clinics and redirect them toward high-risk, vital medical sectors.

Clashing Perspectives: Medical Circles vs. Civic Groups

The announcement has met with fierce resistance from the medical community. The Korean Interdisciplinary Association of Private Practitioners (KAPP) issued a statement criticizing the move, arguing that the proposed rates are lower than what one would pay for a standard commercial massage. "Setting the price of a professional medical act at such a low level undermines the expertise and value of doctors," the association stated. "These rates will make it difficult for many clinics to cover basic operating costs and will ultimately limit patient choice and access to quality care."

In contrast, civic organizations have welcomed the regulation. "My Welfare State," a prominent advocacy group, stated that the transition to the Management Benefit system is a "starting point for normalizing the healthcare system." They argued that excessive treatments by a few institutions have led to a waste of medical resources and increased the burden on the public through higher insurance premiums. The group also urged the government to expand these regulations to other non-reimbursable procedures, such as neuroplasty and extracorporeal shock wave therapy (ESWT).

A New Era of Healthcare Regulation

The regulation of manual therapy is expected to be just the beginning. A representative from the Ministry of Health and Welfare stated, "Manual therapy has been a representative item where controversies over cost-effectiveness and over-treatment have persisted. We will work to minimize confusion in the medical field during implementation and gradually establish management plans for other non-reimbursable items."

As July approaches, the medical industry is bracing for what many call a "Great Transformation." Whether this policy successfully revitalizes essential medicine or leads to a decline in the quality of rehabilitative care remains a subject of intense national debate.

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