건강보험심사평가원 요양급여 적정성평가의 문제와 방향

Abstract

In 2014, there were disagreements between the Value Incentive Program (VIP) of the Health Insurance Review and Assessment Service (HIRA) and academic societies. The primary differences of opinion arose over acute myocardial infarction and stroke, which are the first disease targets of the VIP. The quality of healthcare is one of the three components of the iron triangle in healthcare policy. Improving the quality of care requires effort from both internal approach(medical community) and external approach. The scope of HIRA for improving and monitoring the quality of care could be widened because (as of 2012) HIRA deals with only 16 items of quality improvement and assessment; does not monitor the total scope of medical services, patient safety, and patient experiences; and the VIP of HIRA is contains solely a quality dimension without a cost dimension. Therefore, HIRA should cooperate with medical communities to effectively improve the quality of care and expand procedures for quality improvement, assessment, and monitoring. HIRA must keep in mind that, with regard to improvement of quality of care, its role is not regulatory in nature, but cooperative.