J Korean Med Assoc.  2014 Nov;57(11):927-933. 10.5124/jkma.2014.57.11.927.

The process by which new health technology is listed for insurance coverage

• Kim YJ
• Lee WP

• KMID: 1958393
• DOI: http://doi.org/10.5124/jkma.2014.57.11.927

Abstract

Whether or not insurance covers new health technology has a great effect on the extent of its acceptance and diffusion. Thus many stakeholders vie to participate in determining insurance reimbursement regulations. This paper explains the process by which new health care technology is added to the coverage list in the Republic of Korea,with each checkpoint explained. Our paper also argues that the implication of the listing process of Korean insurance coverage should be modified in the area such as what is the principle of insurance coverage and who will decide the acceptance criteria of health technology, safety, effectiveness, economic feasibility, and relative value.

Keyword

Reimbursement mechanisms; Coverage; New health technology

MeSH Terms

Biomedical Technology*
Diffusion
Insurance
Insurance Coverage*
Reimbursement Mechanisms
Social Control, Formal

Figure

• 

  Figure 1 Listing process of new health technology. HIRA, Health Insurance Review and Assessment Service; MoHW, Ministry of Health and Welfare; NHI, National Institute of Health; RBRVs, resource based relative value scale (From Health Insurance Review and Assessment Service. Benefit standard management [Internet]. Seoul: Health Insurance Review and Assessment Service; 2008) [2].

• 

  Figure 2 Cost effectiveness and coverage decision (From Health Insurance Review and Assessment Service. Benefit standard management [Internet]. Seoul: Health Insurance Review and Assessment Service; 2008) [2].

Reference

1. Jeong HS. An evaluation and proposal of the benefit enhancement plan. Korean J Insur Med. 2011; 6:6–18.

2. Health Insurance Review and Assessment Service. Benefit standard management [Internet]. Seoul: Health Insurance Review and Assessment Service;2008. cited 2014 Oct 17. Available from http://www.hira.or.kr/eng/news/01/1321356_25624.html.

3. Health Insurance Review and Assessment Service. Resource based relative value scale update report. Seoul: Health Insurance Review and Assessment Service;2006.

4. Kim YJ. Improvement proposal of Resource based relative value scale system. Health Policy Forum 2014;12 [Epub]. http://webzine.rihp.re.kr/webzine_201404/w_03_02.html.

5. Lim MH. New health technology assessment and health insurance coverage determinations in Canadian Medicare. Health Welf Policy Forum. 2009; (155):66–76.