Cancer Res Treat.  2020 Jul;52(3):655-660. 10.4143/crt.2020.221.

Choosing Wisely: The Korean Perspective and Launch of the ‘Right Decision in Cancer Care’ Initiative

• Kim JY
• Lee KE
• Kim K
• Lee MA
• Yoon WS
• Han DS
• Ahn SG
• Kang JH

• KMID: 2504447
• DOI: http://doi.org/10.4143/crt.2020.221

Abstract

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.

Keyword

Health Care; Cancer; Cost; Quality; Policy; Right Decision; Initiative

Figure

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  Fig. 1. (A) Current health expenditure in Korea and its components in million constant US dollar, created from the database of the website of the World Health Organization, Global Health Expenditure Database. Source: http://apps.who.int/nha/database/country_profile/Index/en [5,6]. (B) Gross domestic product, public spending, and out-of-pocket expenditure in Korea. As the gross domestic product has increased in Korea, so too has public spending on healthcare. However, out-of-pocket expenditure has not decreased in proportion to the rise in public spending. CHE, current healthcare expenditure; GDP, gross domestic product. Source: World Health Organization, Global Health Expenditure. http://apps.who.int/nha/database/country_profile/Index/en [6].

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  Fig. 2. Out-of-pocket spending relative to final household consumption in 2017 (or the nearest year). Across Organisation for Economic Co-operation and Development (OECD) countries, about 3% of total household spending is on healthcare goods and services. Korea ranks near the top of all OECD countries with spending of 5.6% (red arrow), behind Switzerland (7%). Countries such as Switzerland and The Netherlands have compulsory private health insurance schemes that are supported by public subsidies and laws on the scope and depth of coverage [7].

Reference

References

1. Ministry of Health and Welfare. National Health Insurance: population coverage, contribution rate and benefit payment [Internet]. Sejong: Ministry of Health and Welfare;2016. [cited 2020 Feb 28]. Available from: http://www.mohw.go.kr/eng/hs/hs0102.jsp?PAR_MENU_ID=1006&MENU_ID=100610.

2. Ministry of Health and Welfare. Trends in major death causes (2010-2016) [Internet]. Sejong: Ministry of Health and Welfare;2016. [cited 2020 Feb 28]. Available from: http://www.mohw.go.kr/eng/hs/hs0102.jsp?PAR_MENU_ID=1006&MENU_ID=100602.

3. Ministry of Health and Welfare. Annual report of cancer statistics in Korea in 2016 [Internet]. Sejong: Ministry of Health and Welfare;2018. [cited 2020 Feb 28]. Available from: https://www.ncc.re.kr/main.ncc?uri=english/sub04_Statistics.

4. Organisation for Economic Co-operation and Development. Health at a glance 2019, Chapter 7, Health expenditure p.154: OECD indicators [Internet]. Paris: OECD Publishing;2019. [cited 2020 Feb 28]. Available from: https://doi.org/10.1787/4dd50c09-en.

5. World Health Organization. Global health expenditure database. Health expenditure database. Health expenditure profile of Republic of Korea [Internet]. Geneva: World Health Organization;2018. [cited 2020 Feb 28]. Available from: apps.who.int/nha/database/Select/Indicators/en.

6. World Health Organization. Global health expenditure database. Health expenditure profile of Republic of Korea [Internet]. Geneva: World Health Organization;2018. [cited 2020 Feb 28]. Available from: http://apps.who.int/nha/database/country_profile/Index/en.

7. Organisation for Economic Co-operation and Development. Health at a glance 2019, Chapter 5, Access to care p.113: OECD indicators [Internet]. Paris: OECD Publishing;2019. [cited 2020 Feb 28]. Available from: https://doi.org/10.1787/888934015-809.

8. Financial Supervisory Service. Status of insurance companies' loss insurance coverage, etc. in 2017 [Internet]. Sejong: Korea Development Institute (KDI);2018. [cited 2020 Feb 28]. Available from: https://eiec.kdi.re.kr/policy/materialView.do?num=175876.

9. Financial Supervisory Service. Promotion of cancer insurance policy improvement to prevent cancer hospitalization insurance disputes [Internet]. Sejong: Korea Development Institute (KDI);2018. [cited 2020 Feb 28]. Available from: https://eiec.kdi.re.kr/policy/materialView.do?num=180890&topic=.

10. National Health Insurance (NHI) Service & Health Insurance Review & Assessment (HIRA) Service. 2018 National Health Insurance statistical yearbook. Registration No. 11-B50928-000001-10 [Internet]. Sejong: NHI and HIRA;2018. [cited 2020 Feb 28]. Available from: https://www.nhis.or.kr/menu/boardRetriveMenuSet.xx?menuId=F3321.

11. Cho KH. The challenges faced by the Korean Society for Radiation Oncology in the national healthcare system in Korea. Int J Radiat Oncol Biol Phys. 2014; 90:725–8.

12. Mullangi S, Schleicher S, Feeley TW. Outcome measurement in value-based payments. JAMA Oncol. 2017; 3:1019–20.

13. Spinks T, Albright HW, Feeley TW, Walters R, Burke TW, Aloia T, et al. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America. Cancer. 2012; 118:2571–82.

14. Korean Cancer Association. Objectives and activities of Korean Cancer Association [Internet]. Seoul: Korean Cancer Association;2020. [cited 2020 Feb 28]. Available from: http://www.cancer.or.kr/eng/about/kca.html.

15. Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely: the politics and economics of labeling low-value services. N Engl J Med. 2014; 370:589–92.

16. Tran K, Rahal R, Fung S, Lockwood G, Louzado C, Xu J, et al. Choosing wisely in cancer control across Canada: a set of baseline indicators. Curr Oncol. 2017; 24:201–6.

17. Chalmers K, Pearson SA, Badgery-Parker T, Brett J, Scott IA, Elshaug AG. Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010-2014). BMJ Open. 2019; 9:e024142.

18. Royal Australasian College of Physicians. Evolve recommendations on low-value cares [Internet]. Sydney: Royal Australasian College of Physicians;2020. [cited 2020 Feb 28]. Available from: https://evolve.edu.au/recommendations.

19. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363:733–42.

20. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35:96–112.

21. Parikh RB, Wright AA. The affordable care act and end-of-life care for patients with cancer. Cancer J. 2017; 23:190–3.

22. Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin. 2018; 68:182–96.

23. National Cancer Center. Cancer pain management guideline, 6th edition [Internet]. Goyang: National Cancer Center;2016. [cited 2020 Feb 28]. Available from: http://hospice.go.kr/hospice/front/boardView.do?keykind=&keyword=&page_now3&returl=/hospice/front/boardList.do&listurl=/hospice/front/boardList.do&brd_mgrno=181&menu_no=442&brd_no=88462.

24. Peeken JC, Vaupel P, Combs SE. Integrating hyperthermia into modern radiation oncology: what evidence is necessary? Front Oncol. 2017; 7:132.

25. Datta NR, Rogers S, Ordonez SG, Puric E, Bodis S. Hyperthermia and radiotherapy in the management of head and neck cancers: a systematic review and meta-analysis. Int J Hyperthermia. 2016; 32:31–40.

26. Datta NR, Rogers S, Klingbiel D, Gomez S, Puric E, Bodis S. Hyperthermia and radiotherapy with or without chemotherapy in locally advanced cervical cancer: a systematic review with conventional and network meta-analyses. Int J Hyperthermia. 2016; 32:809–21.

27. Thomas GM. Better radiation therapy for cervix cancer would save lives. Int J Radiat Oncol Biol Phys. 2014; 89:257–9.

28. Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. 2013; 87:111–9.

29. Wortman BG, Creutzberg CL, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, et al. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer. 2018; 119:1067–74.

30. Kim H, Kim JY, Kim J, Park W, Kim YS, Kim HJ, et al. Current status of brachytherapy in Korea: a national survey of radiation oncologists. J Gynecol Oncol. 2016; 27:e33.

31. Min TW. Medical tourism for carbon ion beam therapy (2019 April 2) [Internet]. Seoul: Kookminilbo;2019. [cited 2020 Feb 28]. Available from: http://news.kmib.co.kr/article/view.asp?arcid=0924070627&code=11132000.

32. Kim JY. Choosing Wisely, the Korean perspective: the launch of the nationwide "right decision in cancer care" initiative. Int J Radiat Oncol Biol Phys. 2020; 107:602–3.