Background: The Korean National Health Insurance (NHI) reimbursement guideline was revised in May 2015 with the aim of preventing secondary osteoporotic fractures. Here we compared the: (1) rate of bone mineral density (BMD) measurements; (2) prescription rate of anti-osteoporosis medication within 3 months after hip fracture surgery (HFS); (3) incidence of a second hip fracture; and (4) first-year mortality rate after HFS. Methods: This before-after study used the revised reimbursement system as a reference period. We retrospectively reviewed the medical records of 515 patients who underwent HFS at a tertiary referral hospital between January 2014 and December 2016. The period 1 group underwent HFS in 2014, while the period 2 group underwent HFS in 2016. Results: Despite the fact that there was no significant intergroup difference in BMD measurement rate, the period 2 group had a higher prescription rate for anti-osteoporosis drugs within 3 months of HFS. However, the incidence of a second hip fracture did not differ between groups. The first-year mortality rate was higher in the period 1 versus period 2 group. Conclusions Revision of the NHI guideline in May 2015 was associated with an increased prescription rate of anti-osteoporosis medication in osteoporotic hip fracture patients.