고혈압ㆍ당뇨병 복합질환자를 고려한 적정성 평가 개선 방안

안보령,윤국회,권영근 건강보험심사평가원 심사평가연구소 2022 연구보고서 Vol.2022 No.0

The Health Insurance Review and Assessment Service(HIRA) has implemented a quality assessment program since 2010 to improve the quality of medical care and reduce the risk of cardio-cerebrovascular disease by improving the management quality of patients with hypertension and diabetes. With the increased prevalence of chronic diseases and aging populations, the modern generation generally suffers from multiple (two or more) chronic conditions simultaneously, regardless of the types of diseases. Among the patients targeted for quality assessment, 23.4% with hypertension and 59.4% with diabetes were identified as patients with multi-morbid conditions in 2019. Thus, this study proposed measures for enhancing quality assessment program and redesigning relevant compensation systems considering muti-morbid patients with hypertension and diabetes. Therefore, this study analyzed the current state of quality assessments program of hypertension and diabetes. It also examined international quality assessments systems, such as indicators for assessments and result analysis methods, to derive implications for assessments model design. Moreover, it designed a quality assessment model that considers patients with hypertension and diabetes, based on implications derived from the analytical results of present conditions and international cases. Specifically, it listed preliminary indicators by reviewing existing literature, such as international quality assessment indicators, and Korean and international clinical practice guidelines. Further, it classified the listed indicators as generic and disease-specific indicators. Subsequently, it established a panel of experts and selected quality assessment indicators based on the panel’s opinions. It also examined a method that uses the selected quality assessment indicators to calculate a score based on the clinic unit and presented a grading method according to the calculated score. Finally, this study developed a method for providing incentives based on the unit of a clinic to replace the existing method of incentivizing based on the disease. The developed method reflects the existing method that incentivizes based on the number of patients managed and sections, to consider acceptance of systems among medical institutions. However, the developed method is distinguished from the existing method in that it differentiates the level of compensation according to grades and disease types(e.g., a single disease and multiple diseases). Additionally, this study presented a mid- and long-term direction for quality assessment indicators and compensation systems. quality assessment indicators are constantly required for implementing outcome indicators. Consequently, further research should be conducted to develop a method that reduces clinical burdens on data submission other than the claim data and to adjust the assessment results based on each medical institution by reflecting the patients’ characteristics. The results of this study may be used as the base data for further research on quality assessment improvement.

영국의 활동기반지불제도의 최근동향

안보령 건강보험심사평가원 심사평가정책연구소 2014 HIRA 정책동향 Vol.8 No.1

주요국의 초발 정신병 치료체계 고찰

안보령 건강보험심사평가원 심사평가연구소 2015 HIRA 정책동향 Vol.9 No.4

환자가 보고하는 결과 측정 현황 조사

안보령,정다원,박소정 건강보험심사평가원 심사평가정책연구소 2023 연구보고서 Vol.2023 No.0

Starting in the 2000s, the World Health Organization (WHO), the International Organization for Migration (IOM), and the Organization for Economic Co-operation and Development (OECD), among others, established patient-centeredness as a key element of medical quality, and various countries began to consider the perspective of patients as an essential part in evaluating the quality of medical care and the system of healthcare. Under the current circumstances, where patient-reported outcome measures (PROMs) are receiving attention as a means of measuring patient-centeredness―a key performance indicator of the health care system worldwide, South Korea also needs to discuss the policy value and utilization of PROMs at the national level. In this regard, the National Health Insurance Service plans to strengthen patient-centered health care as a key objective in the evaluation and to measure health outcomes intensively through the development of a patient-centered pool. In preparation for measuring PROMS, this study aims to present the direction of introducing the evaluation of medical quality in Korea through a basic study to understand the status of PROMs measurement in Korea and abroad. It established the concept of PROMs, reviewed cases of PROMs available at the OECD, the International Consortium for Health Outcomes Measurement (ICHOM), the United States, and the United Kingdom, surveyed the status of PROMs implementation in the evaluation of medical quality in Korea, and sought the advice of experts. The following four phases are required to introduce PROMs into Korea’s medical quality evaluation system: (phase 1) defining the purpose of measurement; (phase 2) selecting an appropriate PROM through the exploration and evaluation of PROMs; (phase 3) developing and testing a PROM-based outcomes evaluation system; and (phase 4) finalizing and implementing the outcomes evaluation system. There is a need for continuous patient participation and the expansion of PROMs in the evaluation of medical quality so that patient-centered care can be recognized as a core value within the Korean healthcare system. Furthermore, it is essential to prioritize the introduction of PROMs for diseases of high burden and significance when implementing PROMs in the country. Last, to continuously improve survey tools and develop new areas of research, public and provider participation must be actively encouraged.

광공업지역과 비광공업지역 주민의 자살충동에 영향을 미치는 요인

안보령(Bo-Ryung Ahn),남은우(Eun-Woo Nam),진기남(Ki-Nam Jin),문지영(Ji-Young Moon) 한국보건교육건강증진학회 2009 보건교육건강증진학회지 Vol.26 No.4

2001년 김병익 교수 건강보험재정 건전화 방안 제안 및 10년 후 현실

이규식,안보령 대한의사협회 2011 대한의사협회지 Vol.54 No.12

The late Professor Byung Yik Kim published an analysis of the financial crisis of Korea's National Health Insurance (NHI) in 2001, which derived from the introduction of the separation of prescribing and dispensing. Subsequently, Kim published another paper on policy suggestions to achieve financial stability of the national health insurance in 2002. In his paper of 2001, he had analyzed two causes of the crisis. First, the stepwise integration of health insurance funds had brought about financial instability since 1998, when regional health insurance funds were integrated into one fund. Second, the introduction of the separation of prescribing and dispensing without recognition of financial instability led to financial crisis. In his 2002 paper, he proposed several policy recommendations, including postpone of financial integration among insurance funds, increasing government subsidies, introducing new financing sources for health insurance, such as an alcohol tax, and implementing cost-containment policies. This paper reviews what was changed in accordance with his policy suggestions over the past 10 years. Many policymakers agreed with his analysis on the causes of financial crisis, however, they did not accept his policy recommendations. Consequently, the Korea National Health Insurance is still financially unstable.

의료기관 대상 코로나19 재정지원 제도의 효과 평가: 심층 인터뷰 결과를 중심으로

윤은지,안보령,고혜진,장원모,이진용 한국의료질향상학회 2023 한국의료질향상학회지 Vol.29 No.1

Purpose: The government of the Republic of Korea funded more than ￦15 trillion to healthcare providers to counter COVID-19. This study was conducted to examine the perception of the government funding program; to analyze it; and to explore its future direction to better prepare for upcoming pandemics. Methods: In-Depth Interview (IDI) was carried out of 16 subjects including doctors, policymakers, and professors from 7th June to 13th July 2021. Results: Every participant agreed that the subsidy made a huge contribution to preventing providers from bankruptcy and to stopping a collapse of healthcare system during the pandemic. However, different views occurred in the range of reimbursement. Providers recognized that it should have covered opportunity costs, extra expenses, and financial damage during the pandemic recovery. Whereas, the government perceived that the COVID-19 grant was enough to offset their financial damages. For future responses, most participants admitted that the program should be enhanced to be highly responsive to future pandemics. The standard of reimbursement needs to be eased to raise the funding rates; to reimburse more hospitals; and increase the compensation period and range. Conclusion: A pandemic like COVID-19 is highly likely to emerge more often forward. In a better response to future pandemics, it’s required to level up disaster response capability; to keep healthcare services well-functioning during the emergency; and restructure healthcare system to be resilient even after the pandemic. To this end, an increase in subsidies should be positively reviewed.

요양급여 사전승인제도의 현황과 개선 방안

윤국회,안보령,박소정 건강보험심사평가원 심사평가정책연구소 2023 연구보고서 Vol.2023 No.0

With the rapid development of high-cost drugs to treat rare diseases worldwide in recent times, discussions are actively underway to establish systems for the efficient management of health insurance finances. South Korea’s pre-approval system for reviewing the applicability of high-cost and high-risk medical services has been in operation since 1992, and it is attracting attention as an effective system for managing high-cost healthcare benefit drugs. Despite the implementation of the pre-approval system, there are yet to be studies related to the system. For the system to be established as a more efficient benefits management plan in the future, a comprehensive review of the system is required. This study aims to identify issues in the pre-approval system through a comprehensive review and seek ways to make improvements so that a stable and systematic implementation may be realized. In this respect, this study reviewed domestic and international research literature, analyzed the current system by looking at claim documents, carried out advisory meetings with experts, and surveyed relevant academic societies. Based on the analysis of the pre-approval system over the past five years (2017―2021), there were a total of 21,453 cases of review involving 14,289 patients, with the cost of paid medical expenses reaching KRW 9,277 billion. The number of reviews showed a steadily increasing trend over the years, with average annual increases in review cases (10.3%), claims cases (4.3%), and the number of actual patients (3.8%). The analysis of the current state confirmed the gradually growing impact of pre-approval items on health insurance finances. Furthermore, based on the literature review findings on the purpose of the system, this study proposed the following improvements: ① reestablish the purpose and functions of the system, ② set standards for the entry into and removal from the system, ③ provide a management mechanism post-removal, ④ improve the operational system, and ⑤ establish legal grounds. This study is significant in that it is the first study on the domestic pre-approval system, conducting a comprehensive review of the system. The study, however, needs a professional review of the legal grounds and necessitates reaching a consensus among departments related to the pre-approval system within the review committee and requesting the input of medical professionals to apply the entry and removal standards.

발제5: 경증질환 약제비 본인부담차등제 평가 및 개선방안

오주연,안보령,조상아 한국보건행정학회 2019 한국보건행정학회 학술대회 논문집 Vol.2019 No.1

가치기반 만성질환 통합관리를 위한 운영체계 마련 연구

이근정,최효정,안보령,유승미,엄혜은 건강보험심사평가원 심사평가연구소 2019 연구보고서 Vol.2018 No.0