The Ministry of Health and Welfare released an explanatory document on the 7th regarding the managed benefit system for manual therapy, stating that the system is not intended to ban manual therapy itself or restrict patients' right to treatment. The ministry explained, "Medically necessary treatments will be covered by health insurance, while areas with concerns of overutilization will be managed rationally."

What Is the Managed Benefit System?

Managed benefit is a selective benefit system that comprehensively considers treatment necessity, social benefits, and financial burden to set the price and clinical standards for non-covered items requiring management, applying a 95% patient copayment rate.

Manual therapy is a treatment aimed at relieving pain from musculoskeletal disorders and improving joint function, used in conjunction with existing health insurance-covered items such as physical therapy and rehabilitation therapy. According to an evaluation by the Korea Health Insurance Review and Assessment Service, effectiveness was confirmed for certain spinal and limb disorders, but evidence was insufficient for some conditions, leading to the establishment of appropriate implementation standards based on patient condition and treatment necessity.

Health Insurance Application Criteria and Limits

Under the managed benefit system, manual therapy is covered by health insurance in principle up to twice per week and 15 times per year. However, in cases of joint contracture or stiffness resulting from surgery or fractures, up to 24 sessions per year may be approved based on a doctor's medical judgment.

To qualify for coverage, symptoms must show no improvement after receiving at least four sessions of basic physical therapy or simple rehabilitation therapy over a minimum of two weeks. However, in cases requiring early treatment, such as post-surgery rehabilitation or pediatric torticollis, patients may receive manual therapy without prior treatment based on a doctor's judgment.

If a patient wishes to receive treatment beyond the standard number of sessions, it is possible at their own expense, but health insurance and actual loss insurance will not apply.

Advancing the Review System Using AI

The Ministry of Health and Welfare plans to enhance its management system by utilizing artificial intelligence (AI)-based analysis during the system's operation to monitor repetitive claims, abnormal billing patterns, and other factors. However, actual coverage approval will be determined through review based on medical necessity and clinical standards.

[This article was written with the assistance of AI.]