Table 1.
The Reimbursement and Pricing Categories for Medical Technologies in Japan and South Korea (41), (42).
| Category | South Korea | Japan | |
|---|---|---|---|
| Coverage | Reimbursed | Comparing the technologies with those already listed and placed in the same “functional category,” which has similarity in material, feature, size, etc. | B1 category: placed in the existing functional classification |
| B2 category: placed in the existing functional classification with definition change | |||
| B3 category: placed in the existing category with improvement premium with conditional period | |||
| If the new technology is considered superior to the listed technologies, “Value Appraisal Standard” Innovation Track and Technology Improvement Track are applied for premium pricing and a new functional category is created | C1 category: premium pricing with new functional category creation | ||
| C2 category: new functional category with new procedure code or only new procedure code | |||
| R category: evaluation of remanufactured technologies (reprocessed technologies with new functional category) | |||
| Funded under the procedure (technical) fee (integrated fee schedule of hospital and physician fees) | Low-cost disposable and reusable instruments are paid under procedure fees | A1 category: placed in the existing technical fees that are not linked to the specific procedure fee codes | |
| A2 category: placed in the existing technical fees that are linked to the specific procedure fee code | |||
| A3 category: placed in the existing procedure fees, but change the condition of the fees | |||
| Noncoverage | Cosmetic, not cost-effective or not clinically essential technologies | F category: Not suitable for reimbursement coverage | |