의료 질 평가 사례 연구 -미국을 중심으로-

Abstract

Background: The health care quality assessment system has contributed to quality improvement of medical care in Korea. The first comprehensive plan of National Health Insurance (2019-2023) shed light upon the matter of national-level assessment system implementation for quality improvement and the need of goal-oriented comprehensive assessment system. As the focus of health care service is shifting from volume to value, it is time to discuss introduction of new systems to support quality improvement in response to the changing environment of health sector.

Objectives: This study aims to review the health care assessment systems and case examples of the United States and to investigate lessons and implications for Korea.

Methods: We reviewed health policy reports, academic papers, and webpages (Department of Health and Human Services, Centers for Medicare and Medicaid Services [CMS], and Agency for Health esearch and Quality [AHRQ]).

Conclusion: CMS and AHRQ have developed and put to use various programs for quality improvement. The theoretical concepts of the program, value based purchasing, and programs of using new payment system provide a meaningful foundation for health care quality management. In the future, value-based, patient-centered, medical home, and health data collection are essential for constructing a paradigm. Continuous efforts and management are required to achieve results-oriented interconnectivity, feasibility, and efficiency.