Presentation (CTI)

OBJECTIVES: Understanding how reimbursement and funding mechanisms influence healthcare delivery is important for informing evidence-based access policies. This study examined patient pathways, treatment patterns, and funding mechanisms for peripheral neuropathic pain (PNP) in South Korea, identifying reimbursement-related factors that may affect access to care.
METHODS: A qualitative assessment was undertaken using comprehensive review of literature and stakeholder interviews. Data were collected from healthcare policy sources, reimbursement frameworks, and treatment pathway literature, alongside interviews with clinicians, healthcare financing experts, and patients. Findings were analyzed to identify systemic barriers influencing treatment adoption and patient access. 
RESULTS: South Korea’s healthcare system facilitates early diagnosis of PNP through broad healthcare accessibility and insurance coverage; however, progression to specialized pain management remains inconsistent. Current management is centered on reimbursed oral pharmacologic therapies, while awareness and utilization of alternative treatment approaches remain limited. Stakeholders identified key access barriers, including the absence of dedicated reimbursement pathways for certain non-reimbursed interventions, limited provider incentives for procedure-based care, and affordability challenges. Private health insurance emerged as a complementary funding mechanism for treatments not covered under the National Health Insurance system. Findings suggest that reimbursement design and funding structures influence treatment adoption and may contribute to differences in access across available treatment options.
CONCLUSIONS: This study highlights that access to PNP treatments in South Korea is shaped not only by clinical need and healthcare availability, but also by reimbursement policies, provider incentives, and funding mechanisms. While early diagnosis is generally achievable, gaps in reimbursement structures and treatment awareness may limit access to therapeutic options. Findings suggest that strengthening evidence-informed reimbursement approaches and integrating public and private financing mechanisms could help improve access to a broader range of treatment options. These findings provide insights for healthcare decision-makers seeking to balance access, affordability, and sustainable financing within evolving healthcare systems.