Cost of manual therapy sessions to drop from 110,000 won to 43,850 won — but will 'workaround treatments' follow?

Manual therapy, known in Korea as "dosu treatment," was brought under the national health insurance's managed benefit system Tuesday, overhauling a fragmented pricing structure and tightening coverage standards. The government expects the change to curb overtreatment and stabilize costs, but concerns are already emerging about workaround billing practices at some clinics and restrictions on patients' access to care.

Under the new rules, patients at all levels of medical institutions — from tertiary hospitals to neighborhood clinics — will pay a uniform rate of 43,850 won ($28) per session, with a 95 percent co-payment applied under the managed benefit framework, according to the Ministry of Health and Welfare and the Health Insurance Review and Assessment Service. The previous average cost per session was about 110,000 won, with wide variation across providers.

The ministry said the change had long been needed because manual therapy carried significant price disparities between institutions and, despite having some therapeutic value, was prone to overuse and misuse given its largely elective and supplementary nature.

The managed benefit system brings non-covered medical items deemed medically necessary — but requiring utilization controls — into the national health insurance framework while maintaining a high patient co-payment rate.

Coverage will be capped at two sessions per week and 15 sessions per year. Patients with a clear medical indication of joint contracture or rigidity following surgery or fracture may receive up to 24 sessions annually at a physician's discretion. The same limit applies to pediatric torticollis. Because the system takes effect in July, the full annual session limits will apply through the remaining six months of this year.

Objective assessment and documentation of treatment outcomes will also be mandatory. Providers must administer basic rehabilitation or physical therapy before proceeding to manual therapy, and they will be barred from billing either the national health insurance or patients for sessions exceeding the set limits.

Coverage applies when a physician or physical therapist performs manual therapy for musculoskeletal conditions in sessions lasting at least 30 minutes. Treatments sought for personal purposes — such as fatigue relief or postural correction — will not qualify as medical treatment and will therefore be ineligible for both national health insurance and private indemnity insurance, leaving patients to bear the full cost.

The government expects the new system to reduce unnecessary treatment and bring prices under control. Ko Hyong-woo, the ministry's essential medical care support director, said the reform would stabilize manual therapy pricing and "substantially improve" the problem of unnecessary overtreatment, calling the managed benefit system "an essential measure to strengthen the management of non-covered services."

Medical providers, however, are already discussing ways around the new rules. Practices reportedly circulating in parts of the medical community include splitting sessions — previously 30 to 60 minutes — into 15-minute units, or pairing manual therapy with separately covered physical therapy services.

Jo Mi-hee, head of the benefit strategy division at the Health Insurance Review and Assessment Service, said various "balloon effects" were anticipated. "We plan to monitor phenomena arising from the managed benefit application — such as price increases for non-covered pain treatments — through the non-covered service reporting system and private indemnity insurance data," she said.

On concerns that patients requiring long-term care could see their treatment opportunities curtailed, the government left open the possibility of adjustments. Ko said manual therapy had previously been kept as a non-covered service because of its low evidence rating, and that both medical associations and academic societies had advised that a limit of 15 to 24 sessions per year was appropriate. Private insurance data showed the average patient received 12 manual therapy sessions a year, he added, meaning a 15-session annual cap would cover 95 percent of patients.

Jo also said the agency would "review field opinions and consider expanding access through reasonable alternatives for those who need more," adding that discussions with medical societies on supplementing the system were planned for the second half of the year in response to widespread concerns about patients' right to treatment.

The government plans to evaluate the program's performance every three years and refine benefit categories and detailed criteria accordingly. It is also reviewing whether to bring other non-covered procedures — including percutaneous epidural neuroplasty and radiofrequency hyperthermia — under the managed benefit framework.

There is broad agreement that the reform marks a first step toward reducing overtreatment and stemming losses in the private indemnity insurance system, but the risk of a balloon effect — demand shifting to new non-covered services — remains considerable. Whether the government's promised monitoring and policy adjustments will prove effective is seen as the key variable in determining whether the managed benefit system takes lasting hold.