Health insurance system for hematologic diseases: what should we do?

Korean National Health Insurance (NHI) was introduced in 1963 and became a nationwide health insurance after several law reforms in 1988. As a result of nationalization, coverage has expanded, and its service level has greatly improved since 1998 [1]. However, several diagnostic and therapeutic modalities for rare, incurable diseases such as malignant hematologic diseases are excluded from the reimbursement criteria, and this often complicates physicians’ decision making in terms of evidence-based guidelines. The diagnosis and treatment of hematologic diseases have been rapidly advancing in recent years. However, NHI policy limitations hinder the addition of these advances to standard practice guidelines. Furthermore, the system’s current principle of basic equal sharing regardless of disease severity will inevitably lead to a budget deficit. In this article, we aim to illuminate the insurance problems that arise in the treatment of hematologic diseases under the current NHI and propose solutions to these problems.