Empty treatment rooms, cold winds: South Korea's new manual therapy rules upend clinics

A manual therapy room at an orthopedic clinic in Jeonnong-dong, Dongdaemun-gu, Seoul, was packed with patients as recently as last month. On Thursday afternoon, it was nearly silent. Only two manual therapy sessions were scheduled for the day, and on Monday just one patient out of roughly 150 visitors received the treatment.

On the clinic's bulletin board, the name tag of Kim, the physical therapy team leader, was covered with more than 300 "Kindest Employee of 2026" stickers. Yet the appointment sheet that had been fully booked through last month was mostly empty this month. When the day's second patient arrived just after 2 p.m., Kim greeted them warmly and led them to the treatment room.

"Revenue from manual therapy has dropped 70 to 80 percent since July," Kim said. "If things don't improve after another month or two, we may have to shut down the manual therapy room altogether."

Manual therapy was reclassified as a managed benefit starting Saturday, with a fixed per-session fee of 43,850 won ($30) and a 95 percent patient co-payment. The change is intended to standardize prices — which had varied widely across providers — and curb overtreatment. Under the new rules, treatment is covered up to twice a week and 15 sessions per year. Patients with significantly restricted joint movement due to surgery or fractures may receive up to 24 sessions at a physician's discretion. Clinics must also administer basic physical therapy first and document treatment outcomes.

A woman in her 50s, identified only by her surname initial A, was on her eighth of 15 covered sessions at the Dongdaemun-gu clinic, receiving treatment for a frozen shoulder. She could initially raise her arm only to shoulder height; she has since recovered considerably. Still, fully raising her arm or clasping her hands behind her back remains difficult.

"Manual therapy isn't something that works after one or two sessions — it's about gradually expanding your range of motion," A said. "If I'm only 80 percent recovered when the 15 sessions run out, I may have to live with the remaining discomfort." Kim, the physical therapist, agreed. "Even recovering a single motion like raising your arm can take all 15 sessions," Kim said. "Frozen shoulder is rarely treated surgically, so patients can't easily qualify for the additional sessions reserved for post-surgical cases."

Song Hui-jin, 76, who has been receiving manual therapy for hip and leg pain, also voiced frustration with the session cap. "Past 70, you wake up with pain somewhere new every day — you need to loosen the muscles regularly," Song said. "For older patients, pain keeps coming back. It's hard to just stop after a set number of sessions."

The requirement to complete basic physical therapy before starting manual therapy has also become a significant barrier for patients. Most clinics administer roughly four sessions of basic physical therapy over about two weeks before proceeding to manual therapy. A physical therapist at an orthopedic clinic in Sungin-dong, Jongno-gu, identified only as B, said the prerequisite is especially burdensome for working patients. "Someone who can only come in once a week needs a full month just to complete the four sessions," B said. "Some patients give up midway because they're in pain right now but still have to wait."

Patients have also complained that treatment time has been cut short. A man in his 60s receiving manual therapy at the same clinic for neck and shoulder pain said the sessions feel truncated. "Before, the therapist would check not just my neck but also my shoulders and pelvis, and explain what was causing the pain," he said. "Now it feels like they just work on the sore spot and that's it. The time for exercise guidance and self-care advice has shrunk too."

"This isn't a treatment that works in one or two visits, but the time has been cut in half and the sessions are capped," he added. "I'm worried my recovery will be cut short before I'm done."

With manual therapy fees now fixed, smaller clinics say they lose money the more sessions they provide. According to Kim, the physical therapist in Dongdaemun-gu, a single therapist previously generated around 15 million won in monthly revenue. Under the current patient volume and the new fixed rate, monthly revenue has fallen to around 3 million won. "After operating costs, there's barely enough left to pay the therapist's salary," Kim said.

Clinics across Seoul have already begun suspending manual therapy services. The 365 Dongdaemun Manual Therapy Center in Sinseol-dong, Dongdaemun-gu, halted manual therapy starting Saturday and reassigned its therapists to other services such as extracorporeal shock wave therapy. A rehabilitation medicine hospital in Jongno-gu also discontinued the two or three daily manual therapy sessions it had been providing, effective the same day.

Clinics that have kept the service running are coping by shortening sessions and seeing more patients. At D Orthopedic Clinic in Jongno-gu, three therapists handle 15 to 20 sessions a day, but treatment time has been cut from the previous one hour to around 30 minutes focused on a single area.

"At the old rate, treating one patient for an hour made the clinic viable — at the current rate, it doesn't," said B, the physical therapist in Sungin-dong. "We're barely keeping the room open by cutting session times and increasing volume." B added that a therapist in their mid-40s with children had recently been laid off at a nearby clinic. "Right now it feels like surviving month to month," B said.

The industry also worries that the low fixed rate will drive away experienced therapists and erode treatment quality. "Whether a therapist has two years of experience or five, the clinic gets paid the same," B said. "If clinics can no longer afford to invest in skilled therapists and good equipment, patients will ultimately bear the cost."

Kim, the physical therapist, said the session limits and the crackdown on overtreatment were understandable, but argued that a blanket cut to the fee was misguided. "The abuse by some clinics — bundling expensive manual therapy with other procedures — needs to be stopped," Kim said. "But rather than lumping smaller clinics in with the rest, a price-ceiling approach would make more sense."

Amid the mounting concerns from practitioners, some experts have also stressed the need for the new system. Heo Seong-min, head of the National Physical Therapists Clinical Alliance, predicted that clinics would initially take a wait-and-see approach, but that if patient numbers continued to fall, closures would begin to mount in about three months.

"The reimbursement rate has dropped from an average of 80,000 to 100,000 won per session to around 40,000 won, and the prerequisite physical therapy requirement has further reduced patient intake," Heo said. "Once losses accumulate, clinics will close their therapy rooms or cut staff."

Heo also warned that patients might travel farther to find clinics still offering the service, or turn to unverified alternatives such as meridian massage. "When a low reimbursement rate applies uniformly, hospitals have less incentive to pay experienced therapists higher wages," he said. "If senior therapists are replaced by junior ones, job insecurity and declining treatment quality will feed each other in a cycle."

Jung Jae-hoon, a professor of preventive medicine at Korea University College of Medicine, said the transition to a managed-benefit system was inevitable given how long the manual therapy market had operated and the livelihoods built around it — but added that the government bore responsibility for allowing distortions to grow through years of neglect. "The shift to managed benefits was unavoidable, but the government also let the market run unchecked for so long that it created the very distortions we're now trying to fix," Jung said.

Meanwhile, the Ministry of Health and Welfare said it expects the managed-benefit system to stabilize prices across providers and reduce overtreatment. The ministry plans to evaluate the program's performance and refine the system going forward.