선별급여 제도 개선 및 발전방안
- Type
- Research report
- Issued Date
- 2023-12
- Keyword
- 선별급여; 조건부 선별급여; 근거창출; 성과기반 위험분담제; 가격조정
- Publisher
- 건강보험심사평가원
- Table Of Contents
- 제1장 서론 ··································································· 1
1. 연구배경 및 목적 ··················································································· 3
가. 연구배경 ···································································································· 3
나. 연구목적 ···································································································· 4
2. 연구수행체계 및 추진일정 ······································································· 5
가. 연구수행체계 ······························································································ 5
나. 추진일정 ···································································································· 6
제2장 선별급여 개념 재정립 ··································································· 7
1. 연구방법 ································································································ 9
가. 현황 조사 및 문제점 파악 ··········································································· 9
나. 국내외 문헌검토 ························································································· 9
다. 이해관계자 자문회의 ··················································································· 9
2. 연구결과 ······························································································ 12
가. 선별급여 제도 ·························································································· 12
나. 국내외 유사 제도 ····················································································· 22
다. 급여의사결정 기준 ···················································································· 38
라. 급여의사결정에서 불확실성 고려 ································································· 41
마. 가격결정 및 조정 ····················································································· 55
바. 이해관계자 자문회의 ················································································· 63
사. 선별급여 개념 재정립 ··············································································· 67
제3장 평가항목 유형분류, 평가척도 및 절차 ··································································· 85
1. 개요 ···································································································· 87
가. 평가항목 유형분류, 평가척도 및 평가절차 제도의 필요성과 현황 ··················· 87
나. 평가 유형분류, 척도 및 절차 제도의 문제점 ················································ 89
2. 연구방법 ······························································································ 93
가. 자료조사 ·································································································· 93
나. 유관기관 자문회의 ···················································································· 93
다. 국내외 사례조사 ······················································································· 93
3. 연구결과 ······························································································ 94
가. 평가항목 유형분류 ···················································································· 94
나. 선별급여 평가항목 척도의 개선 ·································································· 98
다. 선별급여 평가항목 절차 제도의 개선 ························································ 107
제4장 근거축적 및 관리 기전 ··································································· 113
1. 연구방법 ···························································································· 115
가. 국내외 의료기술 근거 창출 체계 관련 제도 현황 조사 ······························· 115
나. 체계적 문헌고찰 ····················································································· 115
2. 연구결과 ···························································································· 117
가. 체계적 문헌고찰 결과 ·············································································· 117
나. 국외 제도 고찰 ······················································································· 119
다. 국외 CED 제도 이용현황 및 사례 ···························································· 147
3. 연구결론 및 제언 ··············································································· 297
가. 우리나라 평가방안 및 알고리즘 적용 최종(안) ··········································· 297
나. 우리나라 평가급여 알고리즘 최종(안) ························································ 300
다. 향후 연구 제언 ······················································································· 304
제5장 선별급여 제도 개선(안) ··································································· 305
1. 선별급여 개념 재정립 ········································································· 307
가. 선별급여 제도 세분화 ·············································································· 307
나. 선별급여 의사결정 절차 개선 ··································································· 309
2. 평가항목 유형분류, 평가척도 및 절차 ··················································· 310
가. 평가항목 유형분류 ·················································································· 310
나. 평가척도 ································································································ 311
다. 평가절차 ································································································ 312
3. 근거 축적 및 관리 기전 ······································································ 314
가. 평가 급여 알고리즘 ················································································· 314
나. 평가 급여 근거창출 방안 ········································································· 314
4. 요약 및 제언 ····················································································· 316
◾ 참고 문헌 ···················································································· 320
- Publisher
- 건강보험심사평가원
- Location
- KOR
- Citation
- 김윤. (2023-12). 선별급여 제도 개선 및 발전방안.
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