Rule Making
Medical treatment management procedure
- The healthcare provider applies for NHI coverage of treatment which has obtained safety and efficacy approval.
HIRA assesses its replaceability and cost-effectiveness to determine whether to include the service into the benefit
package, and decide the reimbursement price of the service
- In order to review the target and range of reimbursement, HIRA researches national and international clinical
studies, literature, basic data, and opinions of professionals Standards for reimbursement (for example how many
times it will be covered under NHI) are determined in consideration of service necessity, clinical effectiveness, cost-effectiveness, etc.
- The relative value scale is revised when there are changes in the components of relative value.
Operational Performance
- Data used as the basis material for medical fee payment unit, healthcare statistics and health studies
- Saved national healthcare expenditure by selecting covered services and setting prices in consideration of economic condition
- Unified standard codes make it easier to calculate statistics for disease prediction and public health services across the nation
- Enhanced understanding and acceptability of the program through the coordinating efforts with stakeholders in the healthcare industry
- Operation of national standard treatment code
- Ensure the procedure of introducing new medical technologies
- Facilitate links between computer systems via a standardized code
Medical material management procedure
- The manufacturer or importer applies for NHI coverage of the medical material which has obtained safety and
efficacy approval. HIRA assesses its replaceability and cost-effectiveness to determine whether to include the
service into the benefit package, and decide the upper-limit price of the material. Some of the items are reimbursed
with limitation in terms of applicable disease, number of materials used, and other conditions.
- The listed medical material shall be re-assessed periodically (once in 3 years) in order to improve management efficiency
- Manufacturers and importers may ask for a re-assessment if there is disagreement about the result. The request will be reviewed by an independent body
Operational Performance
- Saved national healthcare expenditure by selecting covered services and setting prices in consideration of economic condition
- Unified standard codes make it easier to calculate statistics for disease prediction and public health services across the nation
- Enhanced understanding and acceptability of the program through the coordinating efforts with stakeholders in the healthcare industry
- Operation of national standard code of medical material
- Facilitate links between computer systems via a standardized code
Pharmaceutical management procedure
- The manufacturer or importer applies for NHI coverage of the drug which has obtained safety and efficacy approval.
The Pharmaceutical Benefit Assessment Committee of HIRA assesses the drug’s clinical efficacy and
cost-effectiveness to determine whether to include the drug into the benefit package
- The price of newly listed drug is determined by the negotiation between pharmaceutical company and NHIS. The price of a generic drug is determined based on a formula in proportion to the original drugs price
- The benefit standards for a listed drug (ingredient) are set either for the whole permitted range or part of range with conditions
- To raise the coverage rate for new drugs, listed drugs are regularly re- reviewed for their value. Listed drugs' status can be adjusted or eliminated from the benefit package if the clinical efficacy turns out to be insignificant
Operational Performance
- High-quality drugs are provided at reasonable price
- Save healthcare expenditure by price determination and selective coverage in consideration of economic evaluation
- Unified standard codes make it easier to produce statistics related to nationwide drug consumption and other healthcare services.
- Enhanced understanding and acceptability of the program through the coordinating efforts with stakeholders in the healthcare industry
