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Quality and Cost of UHC

in South Korea

So Yoon Kim, M.D., Ph.D.


Director, Asian Institute for Bioethics and Health Law,
Yonsei University, South Korea
Contents

1. Current Health Status

2. UHC related policy

3. Quality and Cost

4. Moon care & Future Progress

5. Referance
1. Current Health Status
Republic of Korea

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
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
Trends in Health Indicators in Korea
1960-2017
1960 1970 1980 1990 2000 2010 2017
Life Expectancy Females at birth(years) 55.5 64.8 40.0 75.5 79.6 84.1 85.7
Life Expectancy males at birth(years) 50.6 57.8 61.8 67.3 72.3 77.2 79.7
Life Expectancy of Total population at birth(years) 53.0 61.2 65.8 71.3 75.9 80.6 82.8

2019. OECD Statics


WHO. UHC and SDG country
profile 2018 Republic of Korea
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
2. UHC related policy
Healthcare Purchasing System

Out of Pocket Foreign/Missionary Aid

Healthcare Pricing System

Early Design of Health Insurance Pricing/Collection of Premium

1989
National Health Insurance

Digitalized management Limit Rise of Health Expenditure


History of NHI in Korea

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
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
Governance of NHI in Korea

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
Population Health Coverage
(Unit:1,000 person,%)

36,899
Empolyees
(71.8)
National Health

Insurance
14,042
Total Self-employed
(27.3)
Population

51,360

1,660
Medical Aid
(3.2)

NHIS Statistical Yearbook, (2017)


3. Quality and Cost
History of Quality Improvement
• 1940-1950: Quality management by Deming
• 1951: The Joint Commission: evaluating health care organizations an
d improving safe and effective care of the highest quality and value
• 1962: Kaoru Ishikawa : Engineer in applied chemistry. Fish Bone Diag
ram
• 1966: Avedis Donebedian (MD): 3 types of quality measures; structur
e, process, outcome
• 1960-1979: Philip Bayard "Phil" Crosby: Principle of “Do it right the fi
rst time (DRIFT). “Quality is Free”
• 1990: JCAHO “Agenda for Change” to create more effective means to
improve performance of healthcare organizations(PI)
• 2001: IOM Encourage continuous quality improvement

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Dr Hyunok Kim Do.
Why do we ha
ve to improve?
• Need to reinvent healthcare sy
stems to foster innovations an
d improve delivery of care

• Learning from errors: continuo


us improvement strategies

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Dr Hyunok Kim Do.
Quality & Cost status of Korea
• High Quality, but relatively inexpensive system
• Life Expactation=82.7 yrs(2017)
• Total Health Expenditure as a % of GDP=7.6%(2017)
OECD average = 8.9%(2017)
Life Expectancy of Korea
85,7
81,6 85,2 85,4
83,6
79,7
75,9
82,1 82,4 82,7
70 80,2
78,2
76
64,8 71,7 79 79,3 79,7
76,8
65,8 74,9
55,5 72,3
61,2
67,5

53 61,8
57,8
50,6

1960 1970 1980 1990 2000 2005 2010 2015 2016 2017

Life Expectancy Females at birth(years)


Life Expectancy males at birth(years) 2019. OECD Statics

Life Expectancy of Total population at birth(years)


Total Health Expenditure
as a % of
GDP for OECD Countries
National Health Insurance Expenditure
• Service Utilization type • Health Facilities Type

22%
36% 4% General Hospital
Inpatient 24% 31%
Hospital
Out patient Clinics
42% Phramacies Phramacies
25% 16%
Etc(Hhealth center)

NHIS Statistical Yearbook, (2017)


Health Insurance Medical Institution Cost
Share Status (2013-2017)
2013 2014 2015 2016 2017
Total(A) 510,177 549,492 588,986 652,820 708,111
Rate(%) (100) (100) (100) (100) (100)
General Hosp(B) 157,249 170,121 185,950 211,752 234,192
(B/A) (30.8) (30.8) (30.8) (30.8) (30.8)
Big5 Hosp(C) 27,455 29,690 32,218 36,944 40,868
(C/B) (17.5) (17.5) (17.3) (17.4) (17.4)
(C/A) (5.3) (5.4) (5.5) (5.7) (5.2)

NHIS (2019)
Coverage Decision Science
- Principle, philosophy, governing rule
- Robust, consistent, transparent

Evidence & Value based decision


- Tackling wasteful spending ineffective
(e.g. High cost new technologies with low value
Inefficient use of resource)

Trust building health policy


- Patients preference
- Stakeholders involvement
HIRA’s Digital Health Framework
- Producing Evidence Based Measurable Data
Efficient Healthcare Expenditure Management
“Estimated annual saving, 4.7 billion USD”
Billion USD (%)
80 60
“15.2 billion USD”
70
50

60
HIRA
From 1989 to 2000 From 2000 to 2017
Establishment
: 20.6% : 8.9% 40
50

40 30

30
20

20

10
10

0 0
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Growth rate (%) Health Insurance Exp (Billion USD) Estimated Exp (Billion USD)

2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
HIRA : Quality Assessment

(Estimated)
The number of antibiotics prescriptions Antibiotics prescription drug cost
(Unit: 1,000 cases) (Unit: 1 million USD)
129
41.302 35.3% 28.8% (37million saved)
92
26.716

2008 2016 2008 2016


2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
HIRA: Nationwide Drug Utilization Review
& Distribution Monitoring System

National Level Drug Inventory Monitoring System

Reduced unsafe use of drug Prevented 6.5 million Minimize potential spending
>> Saved USD 31 million avoidable risk prescriptions which could be caused
(2016) (2016) by drug adverse effect
2019.8. GAHL(Global Academy for Health Law & Bioethics)Forum in Korea. Mr. Jongsu Ryu
Medical Dispute Meditation And Arbitration Law (1)
Medical Dispute Meditation And Arbitration Law (2)
Pation Safety Act (1)
• Case in administration of vincristine anticancer drug, in 2010
• Case in patient death from misadministration of anticancer
drug(vincristine) to the myelogram instead of vein during
treatment of leukemia
• Since August 2012, Korea Alliance of Patients Organization has
initiated a „10,000-people-mobile phone message-petition
movement for the legislation of Patient Safety Act‟.
• January 28, 2015: „Patient Safety Act‟ enacted
• July 29, 2016: „Patient Safety Act‟ enforced
Pation Safety Act (2)
Pation Safety Act (3)

Patient Safety Case Report

https://www.kops.or.kr/portal/ 34
4. Moon care & Future Progress
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
Moon Care
Reduce burden of health expenditure over two years

Reimbursement of ultrasound Reimbursement of MRI


Liver, Gall bladder Brain, angiography
50~100$ 300~550$

75~150$
16~50$

2017 2018
2017 2018

YTN News. https://www.yna.co.kr/view/AKR20190702118900017. 01/09/17


Moon Care
Reinforcement of Medical safety net over two years

Lower the level of out of pocket Support catastrophic health


expenditure

1200$ • Four major diseases


• Income below 40%
->>>Less than 50%
830$

2017 2018
The “Big 5” Tertiary Hospital in South Korea
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

• Dr. Dr Hyunok Kim Do, GAHL(Global Academy for Health Law & Bioethics) Forum
presentation in Korea.

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