South Korea’s debate over manual therapy reimbursement has intensified as physicians’ groups warn that proposed changes could undermine access to essential musculoskeletal care. The Korean Medical Association (KMA) has voiced strong opposition to discussions within the National Health Insurance Service (NHIS) about reclassifying manual therapy—known locally as dosu chiryoo—from a standard benefit to a selective benefit with patients covering up to 95% of costs. Critics argue the move, coupled with potential visit limits, would create treatment prohibitively expensive for many patients, particularly those managing chronic pain or recovering from injury.
The controversy centers on proposals to reduce reimbursement rates for manual therapy sessions although considering uniform caps on the number of treatments covered per patient per year. Physicians’ groups contend that such measures fail to account for the varying needs of individuals with conditions like lower back pain, neck disorders, or post-surgical rehabilitation requirements. They argue that a one-size-fits-all approach ignores clinical evidence supporting tailored treatment plans based on patient response and functional improvement.
According to the NHIS, manual therapy accounted for approximately 1.2% of total outpatient benefit expenditures in 2022, amounting to roughly 280 billion won (~$210 million USD). While this represents a small fraction of overall spending, utilization has grown steadily over the past decade, driven in part by aging demographics and increased prevalence of musculoskeletal conditions. The NHIS has stated that rising costs and concerns over unnecessary or prolonged treatment have prompted the review, though officials emphasize no final decisions have been made.
The Korean Association of Physical Therapy (KAPT) has countered that manual therapy, when performed by licensed practitioners, plays a vital role in non-pharmacological pain management and functional recovery. They cite clinical guidelines from the Korean Academy of Rehabilitation Medicine that recommend manual therapy as part of multimodal approaches for conditions such as chronic low back pain, noting its potential to reduce reliance on opioids and invasive procedures.
Internationally, similar debates have unfolded in countries like Germany and Canada, where health systems grapple with balancing access to rehabilitative services against fiscal sustainability. In Germany, statutory health insurance covers manual therapy under physiotherapy benefits with session limits typically tied to diagnosis-specific guidelines, while in Canada, coverage varies significantly by province and private insurance plans.
As of mid-2024, the NHIS has convened multiple stakeholder meetings involving physician associations, physical therapy groups, and patient advocacy organizations to gather input on the proposed changes. No timeline has been announced for when a final decision might be reached, though officials indicate that any adjustments to benefit design would likely be phased in gradually to allow for provider and patient adaptation.
Understanding Manual Therapy in South Korea’s Healthcare System
Manual therapy in South Korea encompasses hands-on techniques used by licensed healthcare professionals—including physicians, physical therapists, and chiropractors—to assess, diagnose, and treat musculoskeletal conditions. These techniques may include joint mobilization, soft tissue manipulation, and stretching exercises aimed at improving range of motion, reducing pain, and enhancing functional movement. Unlike massage therapy, which primarily focuses on relaxation and circulation, manual therapy is clinically targeted and often integrated into broader rehabilitation programs.
Under the current National Health Insurance framework, manual therapy is classified as a standard benefit, meaning patients typically pay a 30% coinsurance rate for covered services, with the NHIS reimbursing the remaining 70% at predetermined fee schedules. The proposed shift to a selective benefit (seonkyeop geumbayeong) would increase patient responsibility to as much as 95%, effectively transforming it into a largely out-of-pocket expense unless supplemented by private insurance.
Selective benefits in South Korea are reserved for services deemed to have lower clinical necessity or higher potential for overuse, such as certain cosmetic procedures or advanced imaging without clear clinical indicators. Reclassifying manual therapy under this category would signal a significant shift in how policymakers view its role in essential care—a perspective strongly contested by frontline providers.
Data from the Health Insurance Review and Assessment Service (HIRA) shows that the average cost per manual therapy session in 2023 ranged between 35,000 and 45,000 won (~$26–$34 USD), depending on the provider type and session duration. Under the current 30% patient responsibility model, this translates to an out-of-pocket cost of approximately 10,500–13,500 won per visit. If patient responsibility were increased to 95%, the same session would cost between 33,250 and 42,750 won—amounts that critics say would place routine care out of reach for many, particularly elderly patients on fixed incomes.
Physicians’ groups have similarly raised concerns about the potential impact on rural and underserved communities, where access to specialized rehabilitative care is already limited. They warn that financial barriers could lead patients to delay treatment until conditions worsen, potentially increasing long-term healthcare costs through more intensive interventions later.
Stakeholder Perspectives and Clinical Evidence
The Korean Medical Association has been particularly vocal in its opposition, arguing that manual therapy remains a cornerstone of conservative management for many spinal and peripheral joint conditions. In a statement issued in May 2024, the KMA emphasized that abrupt changes to reimbursement structures could disrupt continuity of care for patients undergoing active treatment plans, particularly those recovering from work-related injuries or managing degenerative conditions like osteoarthritis.
Meanwhile, the NHIS has pointed to international trends where some health systems have implemented utilization controls on rehabilitative services to address concerns about overutilization. A 2023 OECD report noted that several member countries, including South Korea, have explored visit caps or prior authorization requirements for physical and occupational therapy services as part of broader efforts to promote value-based care.
Clinical research supports the efficacy of manual therapy for specific indications. A 2022 systematic review published in BMJ Open analyzed 45 randomized controlled trials and found moderate evidence that manual therapy, when combined with exercise, provides short-term pain relief and functional improvement for patients with chronic low back pain compared to minimal intervention or usual care. The review cautioned, however, that benefits tend to diminish over time without active patient engagement in exercise and self-management strategies.
Providers stress that treatment duration and frequency should be guided by clinical response rather than arbitrary limits. They advocate for models that tie reimbursement to functional outcomes—such as improved mobility or return-to-work rates—rather than imposing uniform visit caps, which they argue fail to distinguish between patients who benefit significantly from extended care and those who do not.
What Patients and Providers Should Know
For individuals currently receiving manual therapy under national health insurance, no immediate changes to coverage or costs are in effect. The NHIS has confirmed that any modifications to benefit design would require advance notice and would not apply retroactively to ongoing treatments. Patients are advised to consult with their healthcare providers about their specific treatment plans and to monitor official announcements from the NHIS regarding potential policy updates.
Those seeking information on current reimbursement rates, benefit classifications, or upcoming stakeholder meetings can refer to the NHIS website (National Health Insurance Service) and the Health Insurance Review and Assessment Service (HIRA), which publish fee schedules, utilization statistics, and policy notices in both Korean, and English.
Professional organizations such as the KMA (Korean Medical Association) and KAPT (Korean Association of Physical Therapy) continue to engage in dialogue with policymakers and provide resources for members navigating potential changes to practice environments.
As South Korea’s healthcare system continues to evolve amid demographic shifts and fiscal pressures, the manual therapy debate reflects broader tensions between ensuring access to non-pharmacological treatments and maintaining the sustainability of public health financing. The outcome of this review could influence how other rehabilitative services are evaluated for coverage in the years ahead.
Stay informed about developments in South Korea’s health policy by following verified updates from government agencies and professional medical associations. Share your perspective on how reimbursement policies affect access to care—your insights contribute to meaningful conversations about building equitable and effective health systems.