HIRA Research

Preface 2021-05-31

Preface

건강보험심사평가원은 우리나라 건강보험제도의 발전과 더불어 국민의료평가기관으로 성장해 왔으며, HIRA시스템의 국제 교류와 협력을 통해 세계적으로 인정받는 전문가 집단이 되었습니다. 2000년 심사평가원 창립 초기, 보건의료 환경에 선제적 대응을 위해서 연구의 역할이 필요했습니다. 그 당시의 연구전담 기구가 현재의 심사평가연구소로 확대되어 보장성강화 정책 지원, 지출 효율화, 의료보장 제도 개선, 의료 질 향상, 적정하고 안전한 의약품 사용, 국제협력 과제 등 보건의료 측면에서의 다양한 연구를 수행하고 있습니다.
연구를 통한 550여 건의 연구보고서 발간과 함께 80여 건의 논문을 국내·외 학술지에 발표하여 연구의 학술적 가치를 향상하였으며, 현재 119명의 연구원들이 건강보험 정책 발전을 위해 활발한 연구 활동을 이어가고 있습니다. 연구결과의 활용뿐만 아니라 2007년부터 ‘HIRA 정책동향’을 발간하여 보건의료 주요 정책현안, 해외동향, 진료경향 분석 등 여러 가지 쟁점에서 정보를 공유하고 논의하는 가교(架橋) 역할을 해왔습니다. 보건의료 환경의 지속적인 변화 속에서 연구와 탐구를 통해 축적한 지식과 실제 현장에서 얻은 정보는 보건의료 전문가로서 심사평가원의 역할을 해나가는 데 매우 소중한 자원이었습니다. 더 나아가 심사평가원은 보건의료의 다양한 연구와 정보들을 국민과 교류하고 활성화할 수 있도록 ‘HIRA Research’를 창간하였습니다.
‘HIRA Research’는 기존의 ‘HIRA 정책동향’에 전문성과 학술성을 강화한 심사평가원의 공식학술지입니다. 앞으로 온라인, 오프라인을 통해 여러분을 찾아뵐 것이며, 보건의료 분야의 전문가 심사를 통해 전문성과 학술성을 확보할 것입니다. 새롭게 발돋움하는 ‘HIRA Research’가 전문학술지로서 자리매김할 수 있도록 여러분의 관심과 성원을 부탁드립니다. 마지막으로 ‘HIRA Research’ 창간호에 논문을 투고해 주신 모든 분들께 감사의 인사를 드립니다. 또한 학술지가 발간되기까지 노력을 아끼지 않으신 심사평가연구소 이진용 소장님께도 감사를 드립니다.

HIRA Research 2021; 1(1): 6-6

Editorial 2021-05-31

HIRA Research를 창간하며

2021년 5월 건강보험심사평가원은 전문학술지 ‘HIRA Research’의 창간호를 발간하게 되었습니다. 2007년부터 발간해 오던 정기간행물 ‘HIRA 정책동향’을 전문학술지로 확대 개편하는 것입니다. 2020년 8월 제가 건강보험심사평가원 심사평가연구소장으로 취임한 이후 ‘HIRA Research’ 창간 작업을 시작했습니다. 가장 큰 이유는 건강보험 관련 정책과 이슈를 전문적으로 다루는 학술지가 없다는 것이었습니다. 물론 ‘HIRA 정책동향’이 있기는 했지만 건강보험과 관련된 다양한 이해당사자의 목소리를 담아내는 데에는 한계가 있었습니다. 또한 전문학술지가 아니기 때문에 게재되는 글의 전문성과 중립성을 담보할 수 없었고, 외부에서는 심사평가원의 기관지라는 인식이 강했습니다. 이러한 이유로 ‘HIRA 정책동향’을 전문학술지로 개편하기로 결정했습니다.
우리 학술지는 의료계, 학계, 시민단체, 정부 등 다양한 현장의 목소리를 반영할 것입니다. 따라서 원저(original article), 종설(review article), 견해(perspective), 서신(letter), 의견(opinion) 뿐만 아니라 수필 등 다양한 형태의 논문 투고가 가능합니다. 이를 통해 가능한 한 다양한 분야의 시각을 통해 의견을 나누고 토론할 수 있는 학술적 공론의 장을 만들겠습니다. 학술지 창간을 위해 지난해부터 여러 가지 준비를 거쳤습니다. 먼저 심사 평가원 직원 대상 학술지 명칭 공모전을 통해 학술지의 이름부터 정했습니다. 또한 학술지 편집위원회를 구성하였고 학술지 운영지침과 논문투고 매뉴얼을 만들었습니다. 뿐만 아니라 학술 성과와 가치를 확산하기 위한 전용 홈페이지를 개설하였고, 외부 연구자의 투고를 적극 지원하기 위하여 홈페이지에 온라인 논문투고·심사시스템을 구축하였습니다. 마지막으로, 전문학술지 형태를 갖추고자 책자 표지와 내지 디자인을 새롭게 구성하였습니다.
이 과정에서 많은 노력을 해주신 편집위원 및 심사평가연구소 직원 여러분께 감사의 뜻을 전합니다.
특히 부편집위원장으로서 많은 도움을 주신 함명일 교수님과 최윤정 박사님, 창간 작업의 총괄을 맡아주신조회규 실장님과 조향숙 부장님, 실무자로서 고생해주신 김정림 박사님과 신양준 주임연구원에게 깊은 감사의 말씀을 드립니다. 우리 학술지는 앞으로도 현장의 다양한 의견을 수렴하고 학술적 논의를 거치는 과정 속에서, 각 분야가 소통하며 정책을 수립해나갈 수 있는 학술 문화를 조성하겠습니다. 이 창간호가 보건의료 환경 변화에 대응하는 건강보험 정책 수립을 위한 공론의 장을 만드는 계기가 될 수 있길 바랍니다. 이 창간호가 나오기까지 도움을 주신 모든 분들에게 다시 한 번 감사의 말씀을 드립니다.

HIRA Research 2021; 1(1): 7-7

Review Article 2021-05-31

Strategies for Improving Healthcare Delivery System in Korea

In Korea, the healthcare delivery system has been centered on the government’s agenda. With the introduction of nationwide health insurance in July 1989, the government’s healthcare delivery system (patient referral system of health insurance) began. The patient referral system of health insurance, which the government has continuously promoted, has only short-term effects and no long-term effects. The cause of the failure of the patient referral system is that the policy problem was wrong defined and only the policy by regulation was implemented. The evaluation of the Korean healthcare delivery system is currently good, although there is a patient concentration toward large hospitals in the capital area. However, the rapid aging, rapid increase in the medical use of the elderly population, and the entry into an era of low growth require improvement of the Korean healthcare delivery system. The definition of policy problem related to healthcare delivery system should be changed into people’s low preferences of local and small medical institutes, not patients concentration of large hospitals in the capital area because the definition of policy is not a phenomenon but a basic cause. The direction of improvement of the healthcare delivery system can be summarized by regionalization and specialization of medical institutions. In order to improve the healthcare delivery system, the policy strategy of support for regional medical institutions after evaluating regional health care should be given priority. And governmental proposals, as well as innovative proposals led by the private sector, should be accepted and tested, and those that pass the test should be officially implemented in the national health insurance. People could select among existing plans and new alternatives. In order to change the medical utilization based on the wants of the people, it is not to regulate the phenomenon of medical utilization, but to change the wants of the people. The change of people’s wants becomes gradually possible when the choice of the people is the basis.

HIRA Research 2021; 1(1): 9-15

Review Article 2021-05-31

Management of Health Services Uncovered by National Health Insurance

In December 2020, a provision for medical institutions to report items, amounts, and details of uncovered medical expenses to the Minister of Health and Welfare was newly established in the Medical Law. This paper aims to estimate the scale and trend of out-of-pocket expenditures for uncovered medical items; to review the government’s plans as well as related literatures for the management of uncovered medical items; and to gather opinions at expert meetings. Of the total current health expenditures in 2019, household out-of-pocket was 47.5 trillion won (30.3%), and “out-of-pocket excluding cost-sharing” was 26.3 trillion won (16.8%). The decrease in household out-of-pocket burden over the past 2 decades has been replaced by the increase of private health insurance premiums, suggesting that the policy has not been sufficiently connected to the burden relief of low-income households. Whether covered or uncovered, a medical item is located at a point in the continuous spectrum between necessity and selectivity. It is most logical to classify medical items according to the size of “necessity of treatment,” and determine the level (height) of co-payment rate accordingly. A medical item changes its position on the necessity-selectivity spectrum. It is a limitation in terms of classification. Suggestions: First, “medical items for which the treatment necessity is confirmed” should be covered by public health insurance, subject to quality management and differential co-payment rates. Second, “items with relatively weak treatment necessity”, currently not covered, should be switched to coverage once their therapeutic natures are confirmed, though their co-payment rates are set high in order to induce “cost-conscious” medical use of patients. Third, even in the case of “items remaining uncovered”, policy measures as follows are required from the perspective of consumer protection: informed consent, data submission, and monitoring when they are provided together with covered items, etc.

HIRA Research 2021; 1(1): 16-22

Review Article 2021-05-31

Performance and Challenges in Implementing the National Quality Assessment Program

The Health Insurance Review and Assessment Service (HIRA) has implemented the National Quality Assessment Program (NQAP) to improve the quality of care. Beginning with five items including a pharmaceutical benefit in 2001, the NQAP has been expanded in measuring 35 items with 347 indicators as of 2021. The results of the NQAP have been publicly disclosed and linked with the Value Incentive Program and Healthcare Quality Evaluation Grant Initiative that is designed to support the improvement of care. The experience from implementing the NQAP provides three implications for achieving the ultimate goal of improving the quality of care: (1) reorganization of the assessment to ensure credibility from the society; (2) expansion of the use of assessment results; and (3) establishment of governance at the national level that enables alignment with plans, strategies, and policies for quality of care and build-up of the strategic partnership with institutions and stakeholders.

HIRA Research 2021; 1(1): 23-30

Review Article 2021-05-31

Review and Assessment to Support Chronic Noncommunicable Diseases Management in the Primary Care in Korea

Korea has launched a new pilot project to increase the quality of chronic noncommunicable diseases management in primary care. Its core components consist of effective infrastructure and collaboration between public and private sectors, care plan and routine regular visit, care coordinator and medical team, and value-based payment system. It is very important Health Insurance Review & Assessment Service reviews and assesses these core components as the outcome of the pilot project. These review and assessment results should be provided to the primary care clinics as positive feedback to remedy shortcomings and increase the quality of care.

HIRA Research 2021; 1(1): 31-35

Original Article 2021-05-31

Perception and Satisfaction of Healthcare Providers at Hospitals on Temporarily Permitted Telephone Consultations during COVID-19 Pandemic

Background: As of February 24th, 2020, teleconsultation using telephone was temporarily allowed to respond coronavirus disease 2019 (COVID-19) pandemic. This is the first case allowing teleconsultation between patients and healthcare providers and they came to experience telemedicine despite its temporary allowance during the COVID-19.
Methods: This study was conducted to examine the acceptance and satisfaction of healthcare providers at hospitals on the teleconsultation program. For doing it, we adopted the focus group interview and individual in-depth interview with healthcare providers on experiences and acceptance to teleconsultation.
Results: In general, healthcare providers presented low acceptance to teleconsultations due to concerns mainly on safety and effectiveness. However, it is notable that healthcare providers presented greater acceptance to teleconsultations when they were provided a guideline from an organization that they worked for regarding the type of patients whom teleconsultation can be offered, clear procedure of reservations and check-in for teleconsultations, days of supply for prescription, and receipt of prescriptions than those without a guideline.
Conclusion: The finding from the study suggested that a teleconsultation program needs to be systemized with guidelines on the situation, the scope, and a target population, such as the elderly population, established relationship between patients and doctors, and the place of provision and reception of teleconsultation. It is also important to streamline procedures for the provision of teleconsultations. For delivering teleconsultations in a more effective and safe way, the adoption of telecommunication technologies enabling visual explanations and observation should be considered as the telephone is the most limited mode of delivering teleconsultation. Last but not least, monitoring and evaluation of teleconsultation should be implemented to improve patient safety and quality of care.

HIRA Research 2021; 1(1): 36-49

Original Article 2021-05-31

A Comparative Analysis on Four European Countries COVID-19 Response: Focused on the 1st Wave

Background: Coronavirus disease 2019 (COVID-19) pandemic has been triggering an inevitable change in society. This study aims to derive implications for the health care system after the COVID-19 era by comparing the characteristics of COVID-19 response in major European countries and health care systems and other factors by country.
Methods: Italy, Germany, France, and the United Kingdom were included as subjects, taking into account the geopolitical location and health care system. As the situation was updated and academic articles were published simultaneously at the time of the literature review, a comprehensive review of academic papers, institutional reports, publications, and media reports was conducted.
Results: European countries Europe countries with a robust public health system and flexible hospital capacity management responded relatively stably to the COVID-19 crisis. To this end, clinicians and public health experts led the active and efficient multidisciplinary research and information sharing, and the health authorities were able to implement bold response policies. From now on, public health crises due to communicable diseases should be regarded as serious threats to human lives, which means to be approached as a health security issue. Health policy should be designed as a means to strengthen national security and to ensure global sustainability.
Conclusion: The public health care system, which is an essential element for overcoming the public health emergency, should be strengthened, and multidisciplinary research and information systems should be facilitated.

HIRA Research 2021; 1(1): 50-63

Original Article 2021-05-31