Abbreviations and Acronyms
Disclaimer
Preface
Executive Summary
1 Payment Systems of National Health Insurance Service
   1.1 FFS (Fee-For-Service)
   1.2 DRG (Diagnosis Related Group)
   1.3 Fixed Pricing
   1.4 New DRG (Diagnosis Related Group)
   1.5 DRG vs. New DRG

2 Background on Introduction of New DRG
   2.1 New DRG Expansion History
   2.2 Medical Billing Formula for New DRG

3 New DRG Management
   3.1 New DRG Applications
   3.2 New DRG Classification Criteria
   3.3 Inclusive & Non-Inclusive Products of New DRG
   3.4 Issues with New DRG Criteria Change

4 Actual Cases of New DRG Inclusive Product Changes
   4.1 Anti-Adhesion Products
   4.2 Disposable Shears (Electric/Ultrasonic)
   4.3 Circular Staplers
   4.4 Intraocular Lens

Appendix 1 History of NHIS Payment System
Appendix 2 Categorizing New Reimbursement Items as Non-Inclusive or Fully Non-Inclusive Exceptions

Table 1 Payment Methods of National Health Insurance Service
Table 2 Summary of 7 disease groups
Table 3 DRG vs. New DRG
Table 4 Medical billing formula for DRG
Table 5 Non-inclusive devices of existing DRG (01 June 2023)
Table 6 Non-inclusive product group codes of existing DRG (01 June 2023)
Table 7 New DRG Expansion History
Table 8 Additional incentives of new DRG pilot program - Hospital/General Hospital
Table 9 Additional incentives of new DRG pilot program - Tertiary Hospital
Table 10 Inclusive and non-inclusive product criteria (based on 2022 guidance)
Table 11 Changes in the number of inclusive products according to 2022 guidance
Table 12 Change in number of therapeutic material products for new inclusive benefits items
Table 13 Number of inclusive products within new DRG reimbursement category
Table 14 Number of inclusive products within new DRG non-reimbursement category
Table 15 B1 Suture Group: automatic suture devices before the Revision
Table 16 B1 Suture Group: automatic suture devices after the Revision
Table 17 Absorbable hemostasis products before the Revision
Table 18 Absorbable hemostasis products after the Revision
Table 19 Hemostatic agents before vs. after the Revision
Table 20 Major Regulatory Changes for Anti-Adhesion Products
Table 21 Production, export, and import of anti-adhesion products 2018-2022
Table 22 YoY Comparison of Single-Use Electric Shear Claims 2019-2020
Table 23 YoY Comparison of Single-Use Electric Shear Claims 2019-2020
Table 24 Major regulatory changes in circular staples
Table 25 Comparison of claims since the introduction of G105 Disease Group
Table 26 Disease Groups and IOL exclusions
Table 27 Historical overview of the National Health Insurance Service
Table 28 Comparison of medical procedures, therapeutic materials, and medicines

Fig 1 Pricing Structure of Long-Term Care Hospital Admission
Fig 2 New Diagnosis Related Group
Fig 3 New DRG billing calculation formula
Fig 4 Gel type Anti-Adhesion Product Guardix
Fig 5 Ethicon Ultrasonic Shear
Fig 6 Utilization of Circular Staples
Fig 7 Tecnis Symfony IOL (Intraocular Lens)
Fig 8 The First Medical Insurance Act in Korea, Chapter 1, Article 1
Fig 9 Chairman Chung of Hyundai at Medical Insurance Council Board Meeting in 1977
Fig 10 A banner celebrating universal medical insurance program nationwide
Fig 11 A poster informing the aunch of the National Health Insurance Service
Fig 12 Paradigm shift from medical insurance to health insurance