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HIRA Research update

Health insurance review & assessment service research

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수록정보
수록범위 : 1권1호(2021)~2권2호(2022) |수록논문 수 : 47
HIRA Research
2권2호(2022년 11월) 수록논문
최근 권호 논문
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저자 : 박지현 ( Ji Hyeon Park ) , 이영기 ( Young-ki Lee ) , 김대중 ( Dae Joong Kim )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 147-159 (13 pages)

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The number of patients with end-stage renal disease who are on hemodialysis (HD) is increasing annually. Various complications and high mortality rates are observed in these patients. Thus, HD units must administer specialized treatments to such patients. With the intent of ensuring the safe treatment of HD patients, the Korean Society of Nephrology initiated HD unit accreditation to manage the quality of HD units, present standard medical guidelines, and establish a network among local medical institutions. Here, we have summarized the achievements of the accreditation program from 2016 to 2022 and have discussed future directions. After HD unit accreditation was proposed in 2009, 5-year pilot programs were conducted for dialysis specialist training hospitals and HD units in metropolitan areas. Since 2016, HD unit accreditation programs have been conducted annually across the country. Among 845 units that applied for accreditation, 681 units (80.6%) received it. The reasons for non-accreditation were as follows: medical doctors, ethics, nurses, withdrawal of applications, and non-participation in the registration projects. The participating units comprised clinics (56.5%), non-university hospitals (27.2%), and university hospitals (16.3%). Approximately 72.7% of the participants applied for re-accreditation. To improve participation rates for accreditation, it is important that accredited facilities receive economic benefits and publicity. Furthermore, HD unit accreditation must be integrated with assessments of HD adequacy (performed by the Health Insurance Review and Assessment Service) in the future. Finally, governmental support is essential for the safe treatment of HD patients and for adequate quality control in HD units.

저자 : 주진한 ( Jin Han Ju ) , 김병수 ( Byungsoo Kim ) , 윤상헌 ( Sang Heon Yoon )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 160-173 (14 pages)

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Upon coverage of a new drug by National Health Insurance in the Republic of Korea, the A-7 pricing is used as a reference for pharmaceutical benefit assessment. However, improvements need to be made regarding a specific formula currently used for the conversion of drug prices because the formula used to obtain the percentages is outdated and there is insufficient evidence on how the percentages were derived. In this study, the characteristics of 10 countries that have implemented external reference pricing and factors that affect drug prices such as profit margins for wholesalers and pharmacies, value-added tax (VAT), and rebates were examined with a focus on ex-factory price (EFP). In addition, we calculated EFP through conversion from each country's drug prices, compared EFP with the pharmacy purchase prices, and based on the above, drew implications for improving the foreign drug price reference values. Our results showed EFP to be publicly available in six countries (United States, France, Italy, Switzerland, Canada, and Australia) and to fall between 58% (United States) and 92% (Canada) of the pharmacy sales prices. Conversion to EFP was possible for drug prices in Germany, the United Kingdom, and Japan, as information such as pharmacy sales prices, profit margins for wholesalers and pharmacies, and VAT is made public. However, only the pharmacy sales prices, not the profit margins for wholesalers, were available in Taiwan. Foreign drug prices referenced are not adopted as-is but serve as meaningful reference values based on which reasonable drug prices can be decided. Therefore, reference values should be precise and transparent, and from such a perspective, EFP may be more suitable as data resources than pharmacy purchase prices. Furthermore, consideration should be given to adding Canada and Australia to the current list of seven reference countries, and information on the drug pricing structure of other countries should be updated periodically.

저자 : 김정림 ( Jeong Lim Kim ) , 조가영 ( Gayoung Cho ) , 곽민정 ( Min Jung Kwak ) , 최윤정 ( Yoon Jung Choi )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 174-182 (9 pages)

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The coronavirus disease (COVID-19) pandemic has placed pressure on health resource capacities. Many countries responded with various measures to control the resource shortage. This study aims to examine the current status of the resources capacity focusing on hospital beds (public beds) and review the response policies to tackle the COVID-19 crisis in major countries (mainly Korea, Japan, and Taiwan). This study searched publicly available official reports, documents, and statistics from the government, public agencies, and related institutions. The pre-crisis bed capacities differed across countries. In Korea and Taiwan, the total number of beds was higher than the Organization for Economic Cooperation and Development average, but the number of public beds was lower than the average. In Japan, the total number of beds, and public beds were higher than the average. To respond to COVID-19, governments have implemented various strategies and policies to manage and mitigate the impact of the crisis on the healthcare system. some policies to boost bed capacity were very similar. The three countries have designated COVID-19 units and expanded hospitals. The collaboration between the health authority and the private hospitals might have been the key to successfully addressing the crisis of COVID-19 given the shortage of hospital beds. Further, the policies of financial incentives and legal regulation under governance were implemented to respond to the surge in demand for care. In light of the prolonged pandemic, timely response policies and the monitoring system of COVID-19 health resources are necessary.

저자 : 김동환 ( Donghwan Kim ) , 유태경 ( Tae Kyung Yoo ) , 이윤예 ( Yoonye Lee ) , 안미라 ( Mira An ) , 안성은 ( Sung Eun An ) , 백상주 ( Sang Ju Baek )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 183-201 (19 pages)

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Background: This study aimed to compare the difference in healthcare utilization public and private hospitals (by hospital ownership) during Coronavirus disease (COVID-19) pandemic in Republic of Korea.
Methods: The study analyzed the national health insurance claim data from January 1, 2019 to December 31, 2021. We performed a panel regression with a fixed effects model using balanced panel data (n=406, time=36). The response variables are the number of inpatients per bed and the proportion of COVID-19 inpatients. The uncertainty was measured by volatility (calculating standard deviation) of daily confirmed cases of COVID-19. An interaction term between volatility and public hospital was included as an explanatory variable. In addition, region population, geospatial accessibility, the number of beds, the ratio of negative pressure isolation beds, and COVID-19 severity were included as control variables.
Results: As a result of panel regression analysis, for aggregation of data, (1) the volatility of daily confirmed cases of COVID-19 was not directly related to the number of inpatients per bed. For public hospitals, an increase in the number of inpatients per bed was observed with increasing volatility of daily confirmed cases of COVID-19. (2) For the log-transformed value of the number of inpatients per bed, the time effect of the first wave was -0.488, which was lower than those of the second (-0.328), third (-0.468), and fourth (-0.276) waves. (3) The interaction of volatility and public hospitals was positively associated with the ratio of COVID-19 inpatients.
Conclusion: In this study, quantification of uncertainty is proposed to reduce uncertainty of new infectious diseases. Therefore, it is expected to contribute to the policies on health resources.

저자 : 윤세영 ( Seyoung Yun ) , 안성복 ( Song Vogue Ahn )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 202-218 (17 pages)

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Background: This study is to compare the job stress and burnout of nurses who care for patients diagnosed with the coronavirus disease 2019 (COVID-19) and nurses who care for patients not diagnosed with COVID-19 during the COVID-19 epidemic.
Methods: This study conducted a survey of 142 nurses through Instagram and the chatting program of Kakao from November 7 to 17, 2021. They were asked to fill out the questionnaire, and 134 copies were used for the final analysis, excluding eight copies that were not sincerely filled out. The data were analyzed using the IBM SPSS ver. 26.0. Frequency distribution, percentages, means, and standard deviations were acquired, and the t -test was done. The data was under logistic regression analysis.
Results: Nurses who cared for patients with COVID-19 reported a significantly lower odds ratio (OR) of exhaustion than nurses who did not care for patients with COVID-19 (OR, 0.23; 95% confidence interval [CI], 0.08-0.66). Those who did not care for patients with COVID-19 reported a significantly lower odds ratio of disengagement from work than those who cared for patients with COVID-19 (OR, 0.24; 95% CI, 0.09-0.61).
Conclusion: There was no significant difference in job stress between the two groups of nurses. But, the nurses caring for patients with COVID-19 reported significantly lower levels of exhaustion than those who did not care for such patients. This study has the limitation of not being able to identify the confounding effect caused by any confounding variable. It is hoped that programs to resolve the job stress and burnout of nurses will be developed in the future.

저자 : 정윤빈 ( Yoon Bin Jung ) , 이강영 ( Kang Young Lee )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 219-234 (16 pages)

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Background: With the aim of improving the safety and quality of medical care of inpatients, the hospitalist system was implemented as a pilot project from September 2016 in Korea. Based on the clinical results from the pilot project, the government promoted the hospitalist system to a regular service in January 2021 with the establishment of a new fee schedule. In this study, the current status of the hospitalist system in Korea and suggestions for the future direction of the new system are described.
Methods: Data on hospitalists' demographics were obtained from the Ministry of Health and Welfare through a request for information disclosure. The claims data for the fee schedule of the hospitalist service was obtained from the Health Insurance Review and Assessment Service database and analyzed.
Results: As a result of analyzing the national health insurance claim data from 2018 to 2021, the use of the hospitalist system was concentrated in tertiary hospital and metropolitan areas. In addition, the proportion of weekday model in which hospitalists treat patients only during the daytime was higher than the full-time model in which hospitalists treat patients all day.
Conclusion: The national implementation of the hospitalist system is a key paradigm shift in inpatient care. Therefore, all patients should be able to benefit from the hospitalist system regardless of the region or the healthcare institution. For the successful implementation and spread of the hospitalist system, further efforts including changes in the fee schedule are essential.

저자 : 김지현 ( Ji-hyun Kim ) , 김태현 ( Tae Hyun Kim ) , 이상규 ( Sang Gyu Lee ) , 장석용 ( Suk-yong Jang )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 235-244 (10 pages)

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Background: This study investigated the relationship between changes in scores for each dimension of patient experience survey in and changes in hospital overall satisfaction scores in patient experience survey.
Methods: The study subjects were 88 hospitals where the evaluation results of the 1st and 2nd patient experience surveys conducted by the Health Insurance Review and Assessment Service were published. The independent variable is the change in the scores of the five dimensions of the patient experience survey, and the dependent variable is the change in the overall satisfaction score with the recommendation intention and hospitalization experience evaluation as components. Multiple regression analysis was performed by correcting the general characteristics of hospitals, and subgroup analysis according to the characteristics of hospitals was also performed.
Results: The increase in the scores of the medication and treatment score (ß =0.68, p <0.0001) and hospital environment score (ß =0.38, p <0.0001) had a statistical relationship with the overall satisfaction increase. In the model excluding the medication and treatment scores, the change in the hospital environment score (ß =0.45, p <0.0001) was significant with the overall satisfaction score change, and the change in the nurse score (ß=0.26, p=0.055) and an increase in the score of the physician score (ß=0.29, p=0.006) were both associated with an increase in the overall satisfaction score. In the case of changes in the hospital environment score according to the general characteristics of hospitals, there was a consistent effect on the overall satisfaction score change except for hospitals located in the Seoul area and regions with excellent financial independence.
Conclusion: Through this study, it was suggested that improving the physical environment of the hospital can improve the overall satisfaction of patients with the hospital. This will have implications not only for medical management from the point of view of medical service providers, but also for health care policy makers who aim to improve the quality of medical care.

저자 : 오정윤 ( Jeong-yoon Oh ) , 조수진 ( Su-jin Cho ) , 정진선 ( Jin-seon Jung ) , 조진숙 ( Jin-suk Cho ) , 박춘선 ( Choon-seon Park )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 245-253 (9 pages)

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Background: The government has designated the public specialized medical centers for children to support children's hospitals. It announced that it will introduce a new payment system from 2023 to help the centers overcome financial difficulties. However, evidence on the medical capacities of the centers has been lacking. We aimed to investigate the medical capacities of the centers, comparing them with tertiary hospitals.
Methods: We used data for 2021 of the National Medical Center and Health Insurance Review and Assessment Service. The medical capacities of nine centers were compared with 35 tertiary hospitals that were not designated as the centers. We checked the pediatric medical capacities in terms of two aspects: medical resources (facility, medical personnel) and services (case, spending, quality). Descriptive statistics and t -test were used for analyses.
Results: All the centers met the criteria for the designation. There were several centers that did not have the specialists in the subspecialties of pediatrics or surgery. Compared with the hospitals not designated as the centers, the centers had a higher operating rate of pediatric intensive care units and more than twice as many pediatricians. And their medical cases and costs were more than double those of hospitals not designated as centers. The ratio of patients with complex chronic diseases was higher in centers.
Conclusion: The government support for children's hospitals has been focused on investment in facilities until now. Additional government supports will be needed to help centers to continue to provide professional medical services.

저자 : 강경림 ( Kyungrim Kang ) , 예례미 ( Ryemi Ye ) , 이정은 ( Jungeun Lee ) , 권오탁 ( Ohtak Kwon )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 254-262 (9 pages)

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The purpose of this study is to review the necessity of developing a national health management system for children and to develop a pilot project operation model for the establishment of a health management system for children in the Republic of Korea. We analyzed the medical behavior of pediatric and adolescent patients and the status of medical resources using medical expense claims data and medical institution reports with comprehensive consideration of expert opinions. As a result, participants in the pilot project and participating medical institutions were selected. The main service of the pilot project is to explain customized disease-related information and healthcare methods, and provide services for monitoring and managing the progress of the disease if the pediatrician deems that the target child needs professional educational counseling. In addition, pediatricians should explain the need for regular visit management twice a year to children in need of in-depth education and counseling, and provide additional visit management services twice a year to children in need of additional education and counseling. In the future, consistent and systematic evaluation is needed for the continuous development of the pilot project and the promotion of this project, and the preventive health care of children needs to be continuously improved by modifying and supplementing the service provision system through evaluation.

저자 : 신현석 ( Hyunseok Shin ) , 김인호 ( Inho Kim ) , 박소연 ( Soyeon Park )

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : HIRA Research 2권 2호 발행 연도 : 2022 페이지 : pp. 263-270 (8 pages)

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Health Insurance Review & Assessment Service (HIRA) developed two national drug management systems, the Drug Utilization Review (DUR) and Korea Pharmaceutical Information System (KPIS), which have been successfully in operation since 2010. The two systems have drawn interest internationally, and many developing nations are aiming to model their respective national drug management systems after the DUR and KPIS. The drug management systems have the advantage of being applied regardless of the regional regulations or laws, compared to the National Health Insurance System. HIRA has designed a model named the “K-Style Drug Integrated Management Platform”, which contains the integrated features of the DUR and the KPIS. The model was designed to standardize and generalize functions for ensuring the proper use and distribution of the drugs. The most important feature of the K-Style Drug Integrated Management Platform is the functions and responsibilities of the DUR. One of the main roles of the DUR is the prevention of drug misuse; for instance, dispensing drugs, which may harm pregnant women or elder patients. Another prominent feature is the KPIS, whose role is to monitor the distribution of drugs across the country. Through the services provided by the KPIS, monitoring the process of manufacturing, importing, and distributing drugs is made possible. HIRA has also added the feature preventing infectious diseases to the model, as a result of the global issue, which is the coronavirus disease 2019 pandemic. The K-Style Drug Integrated Management Platform will be implemented on the HIRA cloud platform, so the users from various countries will be able to access the integrated drug management system and check the possibility of developing their national plans.

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