- Date2025-04-23
Toughening Up Target & Merit-Centered Quality Assessment
- HIRA releasing ‘2025 National Health Insurance (NHI) quality assessment plan’ -
□ The Health Insurance Review & Assessment Service (HIRA), led by President Kang Jung-Gu, rolled out ‘the 2025 NHI quality assessment* plan’ via its portal - www.hira.or.kr - on January 24, 2025.
* Assessment of quality mainly focusing on safety, effectiveness, efficiency, and patient-centeredness of general medical services including medical procedures, surgeries, etc.
□ Quality assessment began with the assessment of antibiotic prescription rate in 2021. Evenly extended* to acute diseases, non-communicable diseases (NCDs), cancer diseases, mental health, long-term care, and so forth, the quality assessment has improved quality of care.
* 5 items (2001) → 16 items (2010) → 30 items (2015) → 35 items (2020) → 36 items (2025)
□ To implement expectable, organized operation of assessment, HIRA unveils the plan of quality assessment every year.
* ① Reshaped target-centered assessment system and efficient assessment implementation ② Upgraded people-centered assessment and reasonable criteria of assessment ③ Strengthening pay-for-performance and cordial communication with the people
□ First and foremost, the basic principle of HIRA is to specify assessment item-specific goals and to set up a meaningful assessment system with a main focus on assessment result indicators measuring treatment performance, helping the assessment provide a specific and unequivocal message to the people and medical service providers.
○ HIRA anticipates that realigning entire items’ key indicators and forming specific targets are able to ensure objective measurement and management of quality improvement.
* Building up management criteria including target type and target-achieving time per assessment item
□ Furthermore, taking into account assessment environment of recent medical fields as well as lightening the burden of the providers’ assessment implementation, HIRA will also continue to ensure simplifying assessment indicators and making assessment performance efficient.
□ On top of that, it also will proceed with the assessment mainly focusing on essential & critical medical domains and state policies, easing assessment criteria pivoting on patient safety & patient centeredness.
○ Intensive care unit (ICU) prolongs the assessment period from 3 to 6 months, with neonatal intensive care unit (NICU) opening up in advance scores and standardization sections per indicator to ensure target-oriented, expectable assessment.
○ HIRA will continuously make major assessment including the assessment of small and medium hospitals and tuberculosis, as seen in ‘the government policy which reshuffles the medical service delivery system,’ and ‘the 3rd tuberculosis management master plan (2023-2027)’ issued by the Korea Disease Control and Prevention Agency (KDCA),
○ Other examinations such as anesthesia and imaging will forward assessment indicators associated with patient safety, and patient-centered assessment will be reinforced by considering the introduction of a patient-safety assessment section.
□ An autonomous participation regime* of result indicators of hypertension & diabetes operates by linking assessment results with merit, of which the promotion to widen pay-for-performance is expected to arrest providers’ attention more for compensation.
* This regime provides an autonomous right for a medical service provider to select whether to take part in the assessment of result indicators, making compensation for the result.
□ HIRA will energize the people’s participation in the quality assesment system, which will solidify their engagement in the assessment.
○ Additionally, HIRA will actively communicate with the general public by means of public assessment advisory meetings and surveys to amass data, providing a good choice of medical services by disclosing the assessment result of 17 items via HIRA’s portal and the Korea Healthcare Quality Assessment (KHQA).
* Hypertension & Diabetes, Asthma, Chronic Obstructive Pulmonary Disease (COPD), Tuberculosis, ∼ Pharmaceutical Benefits (3), Breast Cancer, Liver Cancer, Hospital Standardized Mortality Ratio, Risk-Adjusted Readmission Rate, Length of Stay Pneumonia, Imaging Examinations, Medical Aided Psychiatry Mental Health, Inpatient Benefits of Long-Term Care Hospital
□ President Kang said “HIRA will redouble its effort for a target & merit-centered quality assessment system to facilitate better public health and substantial assessment, ensuring pliable assessment operation by positively gathering on-site views.
※ Promotion plans per assessment item can be seen in the notice section on HIRA’s portal (www.hira.or.kr) or the KHQA (https://khqa.kr) and detailed plans of new assessment will be separately notified after the discussion on specifics with medical circles, followed then by the deliberation of the Medical Care Assessment Adjustment Committee.
