country case study: korea · 2017-07-29 · involvement in korea. •stakeholders tends to demand...
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Country Case Study: Korea
Jeonghoon Ahn, PhDExecutive Director
NECA
11 Nov 2015
Brocher Workshop
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Healthcare System and
Approaches to Prioritization
• Population: 50,219,669 (2013)
• Health Insurance Scheme (2009): UHC– National health insurance (NHI); 96.7%
– Medicaid; 3.3%
• Operating Principle of NHI– Drug
• New drug; positive listing system
• Existing drug; negative listing system
– Other health technology
• Negative listing system
• New Health Technology Assessment (nHTA) function in NECA plays a gate keeping role (no charge to patient is allowed without passing nHTA)
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Public and Patient Involvement in
Prioritization
• Some public representation in
committees– Consumer organizations
– Labor union representatives
• Recently, some debates on “Citizen
Committee” is increasing– Political intention initiated
– Action: NHIS (Insurer) citizen committee to review
extension of coverage items
– Counter: HIRA (Claim review agency) to add patient
members into their committees (these are appraisal
committees but HIRA sells them as HTA committees)
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Korean National Health Insurance
System
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• Most of Korean Committees in healthcare decision making are “fixed quota” committees • Major quota for ministry and HIRA/NHIS (Gov side)
• Significant quota for providers
• Remaining quota is distributed to health economists.Biostatisticians, and consumer representatives
• The current system puts more weights on representation than accountability or transparency• no member can reveal the contents of meeting
• Validity of decision is achieved through representations of stakeholders
Rationale for Public and Patient
Involvement in Korea
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• Stakeholders tends to demand for more seats not more accountability • Almost the only way to get the contents of
meeting is having a seat in the committee
• Often internal conflicts inside the stakeholding organization incurs• The representative vs the rest of organization
• Alternative channels exist case by case
• Large protests
• Campaign agenda set by administration
• Research results
Overview of Current Success and
Challenges
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• HPV vaccine is not currently covered by any public funding in Korea
• Large demand from the general public exists (many parents pay for their daughters to get the vaccine)
• NECA study initiated by public topic solicitation on “CEA of HPV vaccine as National Immunization Program (NIP)” showed
• Not cost-effective at the current retail price
• May become cost-effective at 70% or less of current retail price and two doses
• The Korean CDC plans to include two dose HPV vaccine into NIP next year
Prioritization Case Study
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Issues Highlighted by the Case
Study
• As an alternative to protests and rallies,
research project is a rare solution in Korea
• More efforts are needed to solicit research
topics from the patients and public
• Bridging the public demand and decision
making through science
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Country Specific Ethical or Social
Values Questions
• None
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Lessons Learnt
• HPV vaccine in NIP will be most likely to
improve equity in healthcare
• On the other hand, “bariatric surgery for
the patients with severe obesity” has long
way to go even though they are more cost
effective than HPV vaccines – Less visible issue in Korea though there exist tens of
thousands of eligible patients (mostly staying home and
afraid of coming out)
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Future Plans
• As Korean society evolves, more demands on
participation will likely to happen and the current
system cannot hold all the demands
– Hopefully, a better participation system for public and
patients to be made in Korea
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