요양급여 적정성 평가체계 혁신 중장기 계획

Abstract

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 longterm 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.