Editorial 2021-11-30

Editorial

건강보험 분야 최초 전문학술지 ‘HIRA Research’ 1권 2호가 발간되었습니다.
지난 창간호에는 의료계, 학계 및 보건의료 관련 단체의 여러 전문가들께서 우리나라의 보건의료 발전 방향과 감염병 대유행 상황에서의 코로나19 대응 관련 분석, 그리고 건강보험심사평가원이 이끌어가야 할 역할 등에 대해 많은 관심을 보여 주었습니다. 이러한 측면에서 HIRA Research는 학술적 교류를 위한 공론의 장으로써 첫 길을 열었다고 생각합니다.
이번호는 더욱 다양한 주제로 구성했습니다. 우선 2022년 대선을 앞두고 건강보험 보장성 강화 등 차기 정부에 바라는 보건의료 정책 의견을 들었습니다. 더불어 임상학회의 입장에서 제안한 혈액투석의 안전성과 질 향상을 위한 정책, 건강보험심사평가원(심사평가원)의 고유 업무인 요양급여 적정성 평가 혁신체계의 중장기 계획을 종설로 담았습니다. 이어 원저에는 의료전달체계 개선을 위한 평가 지표의 적용과 응급의료시스템에 적용할 수 있는 효율적 보건의료 평가 지표 개발에 대한 내용을 포함하였습니다. 최근 디지털 인프라 기술 발달 등의 환경 변화에 맞춰 보건의료 빅데이터 기반의 환자표본자료 추출, 임상데이터웨어하우스 기반의 공통데이터 모델 구축, 인공지능(artificial intelligence) 활용 전략 등을 다뤘습니다. 이러한 연구들은 보건의료 빅데이터를 보유하고 있는 심사평가원의 입장에서 볼 때 향후 빅데이터 활용 전략 설정의 기반이 될 것이라고 생각합니다. 한편 심사평가연구소에서 수행한 건강보험 약품비 증가 요인에 대한 기여도 분석과 국가 정책사업의 일환인 아동치과주치의 시범사업의 기초 연구를 소개하였습니다. 마지막으로 2016년 9월 국내에 도입된 입원전담전문의제도 소개 및 진료활성화를 위한 진료시스템 통합 방안에 대한 내용을 담았습니다. 이번호에서 다룬 여러 시각과 고민들은 보건의료를 둘러싼 다양한 환경 대응에 밑거름이 될 것이라 확신합니다.
HIRA Research는 현재 온라인 논문투고심사시스템을 운영하고 있습니다. 언제, 어디서나, 누구에게나 보건의료 발전을 위한 논의의 기회가 될 수 있도록 문을 열어 놓겠습니다. 다양한 현장의 의견을 학술적으로 수렴하는 역할로써 여러분과 함께 내실을 다져 나갈 것입니다. 창간호에는 공급자 단체, 이번호에는 의료계와 학계의 목소리를 반영했다면, 이제는 정부와 시민단체 등의 의견으로 HIRA Research가 더욱 치열한 공론의 장이 되기를 기대합니다. 감사합니다.

HIRA Research 2021; 1(2): 119-119

Review Article 2021-11-30

Planning for Innovation in the Quality Assessment System of Healthcare Benefits

With the recent spread of remote culture and the development of digital infrastructure technologies, it has become necessary to improve the evaluation system to respond to the upcoming changes in the medical environment. To respond to these changes, Health Insurance Review and Assessment Service (HIRA) selected 23 detailed promotion tasks for innovation and seven innovation tasks in three areas that require priority performance. First, the areas of meaningful evaluation are “a paradigm shift in introducing new evaluations,” “reorganization of evaluation indicators centered on core indicators,” and “redesign of existing evaluation items.” Second, the areas of data collection to promote innovation are “preparing the legal basis and spreading the e-form system” and “expanding the collection of present on admission.” Third, the areas of expanding the use of evaluation results are “selection to enhance public utilization of evaluation information” and “strengthening value-based compensation.” The mid- to long-term plan for innovation in the quality assessment system for healthcare benefit adequacy is first to develop and introduce new evaluations focusing on key indicators such as patient-centered and patient safety-related outcome indicators that can improve national health outcomes. Second, the reform is intended to prepare a legal basis for the smooth collection of evaluation data and switch to the collection of evaluation data using the e-form evaluation form, which is a form for submitting data at the time of claiming medical care benefit costs. Third, it is to improve and operate the current Value Incentive Program focusing on small and medium-sized hospitals and clinics that need to improve the quality of medical care and expand the evaluation items and scale of the additional reduction payment. HIRA is expected to further promote value-based medical quality improvement by doing the following: reorganizing the evaluation centering on key indicators such as outcome indicators that can measure public health performance through the seven tasks and strengthening rewards for health performance improvement.

HIRA Research 2021; 1(2): 132-142

Original Article 2021-11-30

Development of Healthcare Service Delivery Indicator to Strengthen the Function of Each Type of Hospital-Level Medical Institution

Background: This study estimated a single index that evaluates the functional level of medical institutions in the medical delivery system by using both the functional classification result of the medical institutions and the classification result of the suitable disease group.
Methods: Inpatient and outpatient data from the 2019 Health Insurance Review and Assessment Service claim data were used for analysis. Medical institutions above the hospital level were classified into tertiary medical institutions, secondary medical institutions, and regional hospitals (general secondary and limited secondary medical institutions). Using the appropriate disease group classification system of adjacent aged diagnosis-related group (AADRG), the number of AADRG patients suitable for their function was calculated as an index in each inpatient and outpatient area. In the inpatient area, the Charlson comorbidity index was reflected.
Results: The mean of the raw scores for the hospitalization-appropriate disease group of all 525 institutions was 76.8. The raw score for the hospitalization-appropriate disease group showed the highest frequency in the range of 80–90 points (214, 40.8%). The mean of the raw scores for the outpatient-appropriate disease group was 73.9 points. A total of 198 medical institutions (37.6%) were distributed in the 70–80 point range. Regional hospitals were distributed in high scores for both inpatient and outpatient services, and tertiary and secondary medical institutions were distributed in relatively low scores.
Conclusion: It was confirmed that the proportion of medical institutions providing treatment according to their functions was low overall. Based on the results of this attempt to calculate the medical delivery system score, it will be possible to include the medical delivery system evaluation indicator in the medical quality evaluation system and use it as a policy tool to improve the medical delivery system

HIRA Research 2021; 1(2): 143-151

Original Article 2021-11-30

Development of Core Indicators for the Efficient Emergency Medical Service System

Background: Emergency medical services require high-quality data and information to support healthcare delivery and decision-making. In this study, we aimed to develop core quality indicators for the efficient emergency medical services system.
Methods: We systematically reviewed the existing measures of the emergency medical services system. The 84 indicators were selected as candidates across the two domains: general characteristics (patient and emergency medical institution) and emergency medicine (structure, process, outcome). To develop core indicators with professional consensus, the professional expert survey was conducted with selection criteria such as patient safety, effectiveness, efficiency, accessibility, and public health.
Results: The 37 core indicators were selected based on the survey results. The indicators in general characteristics were age, gender, frequency of disease, and so forth in patient domain and the type of emergency medical institutions in emergency medical institutions domain. The indicators in emergency medicine were as follows: the number of emergency professional physicians, physicians, and nurses and the number of beds in structure domain; the patient number of the emergency professional physicians, physicians, nurses, and so forth in utilization domain; the hospital transfer rate in total and three severe emergency diseases in hospital transfer domain; the hospital expenses and clinical procedure and surgery, and so forth in cost and clinical quality domain; the revisit hospital (in 72 hours) and mortality (in 2 days) in outcome domain; the satisfaction of the emergency medical service and disaster preparedness in patient satisfaction domain.
Conclusion: The core indicators could provide valid information for the efficient emergency medical services system. The system can be indicated the direction of the future healthcare policy with respect to resources use and allocation, and healthcare delivery system in emergency medicine.

HIRA Research 2021; 1(2): 152-165

Original Article 2021-11-30

Developing the New National Patient Sample and Evaluating Representations

HIRA Research 2021; 1(2): 166-178

Original Article 2021-11-30

Experience of Converting Clinical Data Warehouse to Common Data Model and Additional Data Loading

Background: Clinical Data Warehouse (CDW) enables healthcare organizations to allow investigators to utilize their anonymous data securely. The Common Data Model (CDM) enables collaborative research between institutions. The authors describe the experience of converting CDW data into the Observational Medical Outcomes Partnership (OMOP) CDM (OMOP-CDM).
Methods: Data from electronic health records of a medical center was converted into OMOP-CDM ver. 5.3.1 (
https://www.ohdsi.org/data-standardization/the-common-data-model/). Source codes of the institution were mapped to the codes in the standard vocabularies. Predefined data were extracted, transformed, and loaded into the CDM tables. Ophthalmologic data were digitalized and structured per their data configuration.
Results: The number of total patients with available data in the CDW was 8,532,392. The data from 878,141 patients were converted into CDM structure after the codes were mapped to those in the standard vocabularies. Visual acuity, intraocular pressure, automated visual field test, and optical coherence tomography were digitalized and stored.
Conclusion: Although it requires plenty of resources to convert the data set to CDM, it is worthy of keeping the activity since it provides opportunities for investigators to participate in various studies.

HIRA Research 2021; 1(2): 179-195

Original Article 2021-11-30

Determinants of Growth in Prescription Drug Spending: Analysis of Drug Spending Contribution Using Index

Background: A rise in pharmaceutical spending has been a considerable concern for national health insurance (NHI). To analyze determinants of growth in pharmaceutical expenditure, using the price index is expected to be useful. The aims of this study are to explore which price index will be used to analyze the determinants of growth in pharmaceutical expenditure and which quantity indicator will be measured.
Methods: We used the NHI data from 2010 to 2019. Pharmaceutical spending was calculated using the components of price and quantity by individual medicine. Also, the three types of index (Fisher index, Laspeyres index, and Passche index) were computed.
Results: The average annual growth rate of pharmaceutical spending was 4.9% overall and 4% for continued drugs. For continued drugs, the price was a declining factor, while quantity was an increasing factor. The Laspeyres index was at the upper limit, Passche index as the lower limit, and Fisher index as the geometric average. For quantity, we considered both days of medication and volume (quantity prescribed per day × the days of medication), and the days of medication were more appropriate due to low variability.
Conclusion: It is important to select an appropriate method considering the data structure, collecting time, and purpose of use. If researchers want to reduce bias towards over-stating and under-stating, it is better to use Fisher index. It will be necessary to continuously analyze factors influencing the growth of pharmaceutical spending using a price index, to make pharmaceutical policy decision-making.

HIRA Research 2021; 1(2): 208-220

Original Article 2021-11-30

A Basic Study for Introducing Pilot Projects and Analyzing the Effects of Children’s Dentists

Background: The government launched a pilot project for health insurance for children’s dentists as one of the measures to expand preventive-oriented essential oral health care services for 3 years from May 2021. We will examine the pilot project targets and project contents of child dentists and analyze the general characteristics between regions subject to the pilot project and children in non-targeted areas to find out whether there are differences between regions.
Methods: This study is a prospective cohort study that lasts for 3 years in a pilot project. The subjects of the experimental group were children in the fourth grade of elementary school living in Sejong city and Gwangju metropolitan city, which participated in the pilot project, and the control group was children in the fourth grade of A elementary school located in Wonju city, which did not participate in the pilot project.
Results: The main results were that there was no regional difference in the general characteristics of the children in the experimental group and the control group. In the comparison of the oral health level, the oral health level was higher in the control group than in the experimental group, but there was no statistically significant difference.
Conclusion: This thesis is a long-term study that starts from the first year of the pilot project and continues until the end. Effect evaluation will be carried out for three years as a pilot project, and through long-term research, we believe that it will be an opportunity to confirm the actual outcomes of the children's dentistry health insurance business and to expand the children's dentistry business.

HIRA Research 2021; 1(2): 221-229

Current Issue Vol. 1 No. 2 Nov 2021

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