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)
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$
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