Korean J Med.  2022 Apr;97(2):65-69. 10.3904/kjm.2022.97.2.65.

New Health Technology before nHTA is also Uninsured Benefit

• Lim C

• KMID: 2528348
• DOI: http://doi.org/10.3904/kjm.2022.97.2.65

Abstract

There has been a misunderstanding that new health technology before new health technology assessment is neither insured benefit nor uninsured benefit. But medical treatment is either insured benefit or uninsured benefit. New health technology is medical treatment. Therefore it shall be either insured benefit or uninsured benefit. It is nothing else. Subparagraph 4 (n) of (attached) Table 2 of ｢Rule for Standard of insured Benefits of National Health Insurance｣ determines whether new health technology is insured benefit or uninsured benefit, which was introduced on Jannuary 1, 2002. Main sentence of the subparagraph 4 (n) states that new health technology is in principle uninsured benefit. The latter part of the subparagraph 4 (n) states that new health technology is exceptionally insured benefit. In a word, the subparagraph 4 (n) state that new health technology is uninsured benefit of main sentence or uninsured benefit of the latter part. In case where the subparagraph 4 (n) does not apply to new health technology, article 41 (2) 2 of the Act applies. this paper calls this “overdetermination”. Overdetermination is three-layered, but only two-layered overdetermination was discussed in this paper.

Keyword

신의료기술; 비급여; 신의료기술평가; 중층결정; New health technology; Uninsured benefit; New health technology assessment; Overdetermination