Even though it is easy to access medical services in Korea, health insurance coverage rate is relatively lower than the average of the OECD countries. In addition, the portion of out of pocket payments for healthcare to the household expenses well exceeds the OECD average. This is ascribed to the fact that there are too many non-covered items and the statutory copayment rates for covered items are high.

Despite the government’s efforts to expand the health insurance coverage over the past few years, the coverage rate remains stagnant due to an increase in the number of non-covered items mainly from new health technologies become available. Such increased non-covered items can add up to the burden of the people and deteriorate the quality of medical services (Ministry of Health and Welfare: 2012).

Most of non-covered items in the diagnostics and examinations  category are ‘procedure’ items. Given an increasing trend of test-related items, there is an ongoing concern that this can increase people’s financial burden. Recently the Korean government announced a national health insurance policy to extend medical coverage to 4 major diseases such as all types of cancer, heart conditions, cerebrovascular diseases, and rare and incurable illnesses (Ministry of Health and Welfare: June 26, 2013).

As several diagnostics and examinations  related items were designated as essential medical services, the ultrasound test switched from a non-covered item to a covered one, and the MRI test is expected to extend to heart diseases, along with the existing coverage of cancers, brain and spinal diseases, starting from the concerned year. As the selective benefit items include the capsule endoscopy with a built-in camera, it is expected to switch to a covered item in the essential genetic test category starting from 2016.

As of now, there is a need to establish the grounds for a comprehensive evaluation to assess a new medical technology whose safety and effectiveness are already proven by the New Health Technology Assessment System or other medical technologies which have a strong social demand to switch from an non-covered item to a covered item, or to review the existing medical technologies which have not been introduced (J Ahn et al, 2012). Therefore, this study aimed to provide data on policy grounds for the evaluation and management of non-covered examination items.