Clinics scale back manual therapy ahead of July coverage shift

Medical institutions are scaling back or halting manual therapy services ahead of the procedure's reclassification as a managed benefit under the national health insurance system starting Wednesday.

The disruption is becoming real as some patients say they can no longer access the treatment they need, and the medical community has taken to the streets in protest.

According to medical industry sources Monday, the rehabilitation medicine department of a Seoul university hospital recently announced it would discontinue manual therapy from Wednesday, when the managed-benefit system takes effect. The hospital plans to replace it with alternative rehabilitation treatments for patients requiring musculoskeletal recovery.

The trend toward reducing or stopping manual therapy is even stronger at private clinics, where the procedure makes up a larger share of services.

Manual therapy had long been excluded from the national health insurance system, leaving prices to vary widely across providers. The arrangement drew longstanding criticism for enabling overtreatment claims through private loss insurance.

In response, the government designated manual therapy as a managed benefit, bringing it under public oversight. It set a uniform price of 43,850 won ($28) per 30-minute session at all medical institutions.

Sessions are capped at 15 per year across all body parts — no more than twice a week — as a general rule. Patients with clear clinical findings of joint contracture or stiffness following surgery or fracture may receive up to 24 sessions annually based on medical judgment.

Coverage applies only when a patient shows no improvement after at least two weeks and four or more sessions of basic physical therapy or simple rehabilitation treatment.

As stricter eligibility conditions combine with a sharp drop in reimbursement rates, clinics are pulling back on manual therapy — and patients are bearing the consequences.

A petition on the National Assembly's public consent platform calling for a policy review and improvements to the managed-benefit system had drawn more than 58,700 signatures as of Sunday.

The petitioner said the managed-benefit classification "gravely violates the constitutional right to health and the professional freedom of healthcare workers," adding that applying blanket restrictions instead of targeting specific cases of insurance fraud, illegal brokered clinics and excessive medical shopping "amounts to burning down the house to catch a flea — an unconstitutional overreach that strips the vast majority of innocent citizens of their right to treatment."

The petitioner urged the government to suspend or scrap the managed-benefit plan and called for the formation of a pan-government rehabilitation medicine consultative body that includes clinical specialists, physical therapists and patients.

Separate petitions are also circulating on the platform on behalf of patients with lymphedema, facial palsy and pediatric conditions, asking that manual therapy be exempted from the managed-benefit system for those groups.

More than 4,000 objections were submitted during the Ministry of Health and Welfare's online public hearing on the proposed regulatory amendment for the managed-benefit transition.

Meanwhile, the medical community launched coordinated collective action ahead of the policy's implementation.

The Korean Medical Association held a rally against the managed-benefit reclassification on Sunday in front of Daehanmun Gate in Jung-gu, Seoul, joined by the Korean Orthopedic Association, Korean Neurosurgical Society, Korean Society of Anesthesiologists and Pain Medicine, and Korean Academy of Rehabilitation Medicine.

The Korean Physical Therapy Association and the Korean Academy of Functional Manual Physical Therapy gathered near Gyeongbokgung Palace for a nationwide physical therapist rally to defend their right to practice manual therapy.

Some medical organizations are preparing to file for an injunction to suspend the managed-benefit reclassification.