OBJECTIVES: Introducing ‘Selective reimbursement scheme’ and reviewing what kinds of medical services were involved in plan to strengthen the NHI coverage for the four major diseases in 2014.  METHODS: The MOHW has been reducing the patient’s co-payment ratio to 50~ 80% from 100% for non-reimbursed medical services that have large demand for the NHI coverage but the cost-effectiveness is low since 2014. A medical service for cosmetic purposes is supposed to be non-reimbursement category. Once a service or product was assigned to selective reimbursed category, reimbursement ratios are determined in 50% or 80% based on the evaluation criteria which has 3 aspects of ‘Clinical Usefulness’, ‘Cost Effectiveness’, ‘Social Demand of Reimbursement’. RESULTS: Based on the evaluation criteria for ‘Selective reimbursement’, total 12 items were assessed and enlisted in selective reimbursement category. This plan benefits 842 thousand patients and reduced non-reimbursement cost to 577 million(2014) from 1,119 million(2012) related to the four major diseases. CONCLUSIONS: NHI coverage is extremely focused on the four major diseases and this will cause discrimination against other diseases. In terms of patients’ aspect, it may be asked whether this plan is effective to give patients an advantage enough to feel under 80% co-payment ratio. The decision making process and medical devices price appraisal remains to be considered as its transparency and rationality.