요양급여 적정성 평가의 성과와 과제

Abstract

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.