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Quality and Cost of Universal Health Coverage in South Korea

This comprehensive analysis examines the current health status in South Korea, related UHC policies, quality, and costs. It covers Moon care and future progress, referencing significant statistics and trends. The text delves into the history and major features of South Korea's National Health Insurance system, governance models, and quality assessment mechanisms. The system's cost-effectiveness in providing high-quality care is highlighted, along with innovative strategies like Pay-for-Performance programs to enhance the overall quality of healthcare services.

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Quality and Cost of Universal Health Coverage in South Korea

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  1. Quality and Cost of UHCin South Korea So Yoon Kim, M.D., Ph.D. Director, Asian Institute for Bioethics and Health Law, Yonsei University, South Korea

  2. Contents • Current Health Status • UHC related policy • Quality and Cost • Moon care & Future Progress • Referance

  3. Current Health Status

  4. Republic of Korea Korea Population • 51.6 million Per capita GDP (PPP) • 38,350 USD Pop. over 65 • 14.3% THE in GDP (Total Healthcare Expenditure) • 7.6% (OECD average:8.8%) As of 2018 Statistics of Korea 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  5. Health Status • Total health expenditure as % of GDP 2014 : 7.4% • Total health expenditure per capita (current US$) 2014 : 2060.25 • General government health expenditure as % of total health expenditure 2014 : 54.1% • Life expectancy at birth (in years) 2015 : 82.3 WHO. UHC and SDG country profile 2018 Republic of Korea

  6. Trends in Health Indicators in Korea1960-2017 2019. OECD Statics

  7. Life Expectancy of Korea Life Expectancy Females at birth(years) 2019. OECD Statics Life Expectancy males at birth(years) Life Expectancy of Total population at birth(years)

  8. WHO. UHC and SDG country profile 2018 Republic of Korea

  9. How does the Republic of Korea compare to other countries in the Region? • Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries WHO. UHC and SDG country profile 2018 Republic of Korea

  10. 2. UHC related policy

  11. History of NHI in Korea 1963 Enacted Medical Insurance Act 1977 Started Medical Insurance Program for employees of large companies 1988 Started Local Medical Insurance in rural areas 12 years 1989 Started Local Medical Insurance in urban areas (Population Coverage) 1999 Enacted National Health Insurance(NHI) Act 2000 Integrated to Single Payer System (Established NHIS and HIRA) 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  12. Major Features of NHI in Korea • ① Covers entire population with all essential services - 97.1% of population is belong to NHI system and 2.9% is belong to Medical aid • ② Dominant health service provider is the private sector - All the providers are mandatorily enrolled in NHI - 93.3% of hospitals are owned by private sector • * The number of provider: 91,545 (as of December 2017) • ③ Single payer system since 2000 - Independent commissioning organization (HIRA and NHIS) • ④ Adopted high end ICT - 99.7% of claims are interchanged electronically • ⑤ National Level Drug Utilization Review Operation & Drug Distribution Monitoring System • ⑥ Depends largely on Fee-For-Service payment system - Out-patient: Fee For Service 99.66%, Per-Diem 0.34% - In-patient: Fee For Service 80.68%, Per-Diem and DRG 19.32% 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  13. Total Health Expenditure as a % ofGDP for OECD Countries

  14. Organization and governance

  15. Organization and governance Single insurer with two organizations • National Health Insurance Corporation (NHIC) • Health Insurance Review and Assessment (HIRA) Two categories in NHI • Employee insurance • Self-employed insurance

  16. National Health Insurance Expenditure • Service Utilization type • Health Facilities Type NHIS Statistical Yearbook, (2017)

  17. Contributions

  18. Insurance Benefits and Co- Payments

  19. 3. Quality and Cost

  20. Governance of NHI in Korea MINISTRY OF HEALTH AND WELFARE Legislation, NHI organization supervision HIRA NHIS Health Insurance Review & Assessment Service National Health Insurance Service • Make rules for benefit • Monitor • Digitalized NHI System Infrastructure • Collect contribution • Negotiate with providers for fee level • Promote health and prevent disease List, price, coverage Cost, Quality, and Patient Satisfaction Strategic Purchasing Collecting and Pooling 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  21. Cost & Quality • High Quality, but relatively inexpensive system • Life Expactation=79.8 yrs(2014) • Total Health Expenditure as a % of GDP=7.8%(2013)

  22. System: Quality Assessment • Quality Assessment (QA) prevents healthcare providers’ overuse, underuse, and misuse of healthcare servicewhile also bridging the gap between providers’ healthcare quality to ultimately have an upward leveling effect • Pay-for-Performance (P4P) system called Value Incentive Program (VIP) has led providers to make more active quality improvement efforts • 62 Quality indictors in 14 areas; Mental disease, Cancer, Patient-centeredness etc. < Quality Indicator Improvement through HIRA’s QA activities > (Estimated) The number of antibiotics prescriptions Antibiotics prescription drug cost (Unit: 1,000 cases) (Unit: 1 million USD) 28.8% (37million saved) 35.3% 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  23. System: Nationwide Drug Utilization Review & Distribution Monitoring System • DUR is a system that minimizes and prevents unsafe use of drug by reviewing prescriptions and by comparing them to the national safety standards at the time of prescription and dispensing Importation / Manufacture Tracing TransactionsVolume & Price (Transparency) Safety Check /National Level Prescription Monitoring Prescription Hospital Importer / Manufacturer A Supplier B Supplier 5 3 2 4 1 6 Dispensation Pharmacy National Level Drug Inventory Monitoring System Prescription Information Pharmaceutical information for safe use of drug Pharmaceutical information for safe use of drug Completed Prescription Dispensing Information Pharmacy Patient Healthcare provider Final dispensing Information Issue Prescription Dispensing Minimize potential spending which could be caused by drug adverse effect Prevented 6.5 million avoidable risk prescriptions (2016) Reduced unsafe use of drug >> Saved USD 31 million (2016) 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  24. HIRA’s Achievement in Digital Health Framework - Producing Evidence Based Measurable Data Efficient Healthcare Expenditure Management “Estimated annual saving, 4.7 billion USD” Billion USD (%) “15.2 billion USD” HIRA Establishment From 1989 to 2000 : 20.6% From 2000 to 2017 : 8.9% 2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu

  25. Review & Assessment

  26. National Health Insurance Benefits Adult Health Screening • Cost : Free • Eligible : Employee insured, All householders, Dependentsofemployee or members of household aged over 40 • Screening Cycle and items : Biennial except for non-office workers(annual), with 1st step 21 items, 2nd consultation • Cancer Screening Program : 10% Copayment (Free for lower 5 deciles)

  27. Change of Financing 1989

  28. 4. Moon care & Future Progress

  29. Population Health Coverage (Unit:1,000 person,%) NHIS Statistical Yearbook, (2017)

  30. A function summary chart for South Korea (2010) The category ‘other’ in the revenue collection row includes contributions from private non-profit organisations and private companies

  31. Moon Care Reduce burden of health expenditure over two years • 36 million people for reduce 220 billion won • Reduce 80 billion for Vulnerable group • Reduce of out of pocket money 14 billion won • Reduce medical fees around ½ to ¼ for serious case patient • Reimbursement of ultrasound, MRI

  32. Moon Care Reduce burden of health expenditure over two years Reimbursement of ultrasound Reimbursement of MRI Brain, angiography Liver, Gall bladder 300~550$ 50~100$ 75~150$ 16~50$ 2018 2017 2017 2018 YTN News. https://www.yna.co.kr/view/AKR20190702118900017. 01/09/17

  33. Moon CareReinforcement of Medical safety net over two years Lower the level of out of pocket Support catastrophic health expenditure Four major diseases Income below 40% ->>>Less than 50% 1200$ 830$ 2017 2018

  34. The “Big 5” Tertiary Hospital in South Korea

  35. Health Insurance Medical Institution Cost Share Status (2013-2017) NHIS (2019)

  36. 4. Reference • National Health Insurance Service https://www.nhis.or.kr/retrieveHomeMain.xx • YTN News. https://www.yna.co.kr/view/AKR20190702118900017 • WHO. UHC and SDG country profile 2018 Republic of Korea • NHIS Statistical Yearbook, (2017) • WHO. UHC and SDG country profile 2018 Republic of Korea • Health Insurance Review & Assessment Service https://www.hira.or.kr/main.do • Mr. Jongsu Ryu, GAHL(Global Academy for Health Law & Bioethics) Forum presentation in Korea.

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