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HOME > About HIRA>What HIRA DO>Performance indicators about major businesses

Performance indicators about major businesses

○ Overview of Indicator Selection
- For objective public agency’s management performance evaluation, Ministry of Economy and Finance -led ‘Management Performance Evaluation’ system is ongoing
- To reach the goal and implement of major value of HIRA, select and operate indicators shown as below for performance indicators about major businesses (as of 2018)


Overview of Indicator Selection
Category Name of Indicator Def Index Calculation Formula
Medical Fee Review Appropriate treatment rate With encouraging institution’s autonomous treatment improvement in terms of Cost, Quality and Safety, indicators for assessing efforts to set appropriate treatment environment and prevent occurring inappropriate treatment cost

Appropriate treatment rate =

Total no. of institutions with appropriate treatment by cost, quality and safety [(no. of institutions reaching the goal for 2~3 quarters×0.6)+(no. of institutions reaching the goal for the whole quarters×1.0)]

Total no. of institutions evaluated with by each item

× 100

*Numerical Goal by each item

Numerical Goal by each item
Cost Less than 1.1 Visiting Index(VI), Less than 1.0 Costliness Index(CI)
Quality Less than 70% of acute upper respiratory infection antibiotics prescription rate, Less than 40% of prescription rate with injections & no. of line-item (over 6 items)
Safety Less than 30% of long-term prescription rate for psychotropic drug (Benzodiazepine related drug) for over 65-year-old
Health Insurance Finance Reduction Performance With Health insurance medical fee review, indicators for assessing efforts to reduce health insurance finance reduction by encouraging error·fraud claims prevention and appropriate & correct claims

Health Insurance Financing Reduction Performance: Pre-claims review cost+Claims review cost+Post detection cost

Health Insurance Financing Reduction Performance
Pre-claims review Indicator-Linked Management Cost Expected medical fee-Real medical fee from institutions controlled by Indicator-Linked Management
Claims Error Check Prevention Cost Prevention and Amendment cost by claims error check service
Claims review Adjusted Cost by the first stage review Adjusted cost for submitted claims
Post detection Cost of Detected Fraud Claims by on-site investigation Error·Fraud claims fee detected in on-site investigation after paying
Medical Service Quality·Safety Evaluation Medical Service Quality Improvement Rate With medical service quality assessment, indicators for assessing efforts to create safe healthcare environment by each institution

Average improvement rate by each evaluation item: Average improvement rate of composite score

Medical Service Quality Improvement Rate =

Total improvement rate of healthcare quality by each evaluated item

no. of evaluated items

× 100

Health Insurance Policy Supporting Expand Health Insurance Coverage Indicators for measuring year by year performance goal for Health Insurance Coverage as national affairs

Goal achievement of expanding uncovered service according to Health insurance coverage strengthening policy

Goal achievement of expanding uncovered service =

no. of implemented accumulated expanding covered items in evaluation year

no. of targeted accumulated expanding covered items in evaluation year

× 100

Health Insurance Policy Development Performance Indicators for covered service improvement reflecting current medical status and systematic managing performance for uncovered service medical cost

Health Insurance Policy Development Performance = no. of covered service standard improvement ×0.2 + no. of publicized items in uncovered service fee ×0.8

Numerical Goal by each item
No. of covered service standard improvement no. of legislation & notification from responsible agency among Health Insurance covered service policy criteria development·report
Publicized items package in uncovered service fee no. of publicized items package with standardizing information after uncovered service investigation·analyze by each institutions