2027 Medical Fee Schedule: NHIS Finalizes Increases Amidst Clinic Negotiation Breakdown
The South Korean National Health Insurance Service (NHIS) has officially concluded negotiations for the 2027 medical care benefits fee schedule, settling on an average increase of 1.65% for medical institutions. While agreements were reached with most provider groups, the negotiations with clinic-level institutions ended in a breakdown, marking the first time in two years that a consensus was not achieved for this category.
Understanding the 2027 Fee Adjustments
Medical fees, or “수가” (suga), represent the payments made by the government to medical institutions for services rendered. These are determined by multiplying a “conversion index” by a “relative value score” for each specific procedure. The finalized 1.65% average increase is composed of a 1.45% rise in the conversion index and a 0.2% adjustment linked to relative values.
The distribution of these increases varies by institution type to address regional and essential care needs:
- Hospitals: 1.2% (1.3% for long-term care and psychiatric hospitals)
- Dental: 2.6%
- Korean Medicine: 3.0%
- Pharmacies: 3.7%
- Midwifery Centers: 6.0%
- Public Health Institutions: 2.7%
To ensure fairness and bolster undervalued medical services, hospitals will dedicate 0.1% of their increase to essential and undervalued procedures. Similarly, dental and Korean medicine providers will allocate 0.2% and 0.1% respectively toward consultation fees and related items.
Clinic-Level Negotiations: A Point of Contention
The clinic category, represented by the Korean Medical Association, failed to reach an agreement with the NHIS. The service had proposed an increase of 1.6%—comprising a 1.1% conversion index hike and a 0.5% relative value-linked adjustment—but this offer was rejected. The final fee schedule for clinics will be determined by the Health Insurance Policy Deliberation Committee.
The NHIS cited the necessity of maintaining the fiscal soundness of the health insurance fund, especially as the nation faces rising medical costs associated with a super-aged society. The total additional expenditure resulting from these fee adjustments is projected to be approximately 1.2058 trillion won.
Key Takeaways for the Healthcare Landscape
- Fiscal Responsibility: The NHIS emphasizes the need to balance support for essential medical infrastructure with the long-term sustainability of the national insurance fund.
- Ongoing Policy Integration: In line with the Second Comprehensive Plan for National Health Insurance (2024–2028), the government is increasingly linking conversion indices to relative values to correct historical imbalances in medical compensation.
- Future Impact: Because the health insurance fund is supported by premiums, these upward adjustments in medical fees may influence future health insurance premium rates for the public.
As the sector moves forward, the focus remains on navigating the tension between providing fair compensation to medical providers and ensuring that the healthcare system remains accessible and affordable for all citizens in the face of shifting demographic realities.