한국 건강보험 시범사업에 대한 메타평가 연구

Abstract

Background: Pilot projects in Korea’s National Health Insurance (KNHI) system have been instrumental in testing innovative healthcare policies. However, frequent personnel changes and inconsistent evaluation mechanisms challenge the continuity and effectiveness of these projects. This study aims to perform a meta-evaluation of pilot projects to assess their implementation, evaluation, and policy implications. Methods: A meta-evaluation framework was developed to analyze 49 pilot projects conducted between 2014 and 2023 focusing on three key elements: inputs, processes, and outcomes. Data were collected from publicly available reports and government records. Key evaluation components included input resources, process integrity, and outcome feedback. Mixed methods, combining quantitative and qualitative data, were utilized. Results: The analysis revealed inconsistencies in the allocation of evaluation personnel and a lack of independence of the evaluating organizations. As for the evaluation processes, randomized and quasi-experimental designs were generally employed, ensuring objective evaluation methods, and appropriate indicators and analytical approaches were largely utilized. However, for evaluation outcomes and feedback, only 11 of 49 projects demonstrated effective feedback implementation, and transparency of the evaluation reports was identified as a significant issue. Conclusion: Despite their strategic importance, KNHI pilot projects face systemic issues in evaluation and continuity. Enhancing evaluation transparency, establishing consistent guidelines, and addressing staffing challenges are crucial for maximizing their policy impact. This study underscores the need for a more structured evaluation system to ensure the sustainability and scalability of pilot projects.