South Korea Strengthens Oversight of Manual Therapy (Dosu-Chiryo) Under National Health Insurance
The South Korean government has implemented new management and oversight standards for manual therapy—known locally as dosu-chiryo—to ensure medical necessity and curb excessive utilization within the National Health Insurance (NHI) system. While these measures introduce stricter documentation and monitoring requirements for healthcare providers, the Ministry of Health and Welfare maintains that patients requiring medically essential manual therapy will continue to receive coverage under existing insurance standards.
Why Is the Government Updating Manual Therapy Standards?
The primary driver behind these policy adjustments is the rapid growth in medical expenditures associated with non-surgical, musculoskeletal treatments. According to the Ministry of Health and Welfare (MOHW), manual therapy has seen a significant surge in claims, leading to concerns regarding the sustainability of the national insurance fund. By establishing clearer criteria for “medically necessary” treatment, the government aims to distinguish between therapeutic interventions required for recovery and those categorized as purely elective or preventive, which are not intended to be covered by public funds.
Health authorities are focusing on the documentation of clinical outcomes. Providers are now expected to demonstrate that manual therapy is part of a broader, evidence-based treatment plan. This move aligns with broader efforts by the National Health Insurance Service (NHIS) to implement value-based care models that prioritize patient outcomes over the volume of services rendered.
How Do These Changes Affect Patients?
For the average patient, the core mandate of the policy is to verify that manual therapy is prescribed based on objective clinical findings rather than patient preference alone. Patients who present with verified musculoskeletal conditions—such as chronic back pain, herniated discs, or post-surgical rehabilitation needs—will not see a change in their ability to access care, provided the treatment follows established clinical guidelines.
The Health Insurance Review and Assessment Service (HIRA) has indicated that it will intensify its review of claims that deviate from standard treatment frequencies. Patients may notice that their physicians perform more frequent diagnostic assessments or request updated imaging, such as X-rays or MRIs, to justify the continuation of manual therapy sessions. This ensures that the NHI acts as a safety net for those with legitimate medical needs while reducing the burden of unnecessary costs.
What Are the Key Differences in Provider Requirements?
Under the updated framework, clinics must adhere to stricter reporting protocols. The following table contrasts the previous environment with the current regulatory expectations:
| Feature | Previous Standard | Current Standard |
|---|---|---|
| Documentation | General session notes | Detailed clinical justification required |
| Review Frequency | Periodic/Random | Targeted and frequent audits |
| Medical Necessity | Provider discretion | Defined by objective diagnostic criteria |
What Happens Next for Musculoskeletal Care?
The government intends to monitor the impact of these regulations on both healthcare spending and patient access to care over the coming fiscal year. The Ministry of Health and Welfare has stated that it will refine these criteria based on data gathered from the ongoing reviews. The ultimate goal is to stabilize the insurance fund while ensuring that the quality of musculoskeletal care remains high. For patients, maintaining clear communication with their attending physicians regarding their treatment plan and diagnostic progress is the most effective way to ensure uninterrupted coverage for necessary manual therapy services.
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