The Health Insurance Review & Assessment Service(HIRA) is involved in the review of reimbursement for medical care expenses to manage the Korean government’s healthcare spending, the assessment of cost relevance and the underpinning of government policies. For this purpose, HIRA operates a variety of separate committees.
Each committee’s decision making is reflected in the review and assessment of medical fees, affecting healthcare supply and consumption behaviors. As such, evidence-based healthcare (EBH) assessment was introduced to ensure fast, relevant and highly reliable decision making.
To support each committee’s effective decision making, the HIRA organized an EBH team in 2007 and began to use the approach. As a standard assessment tool, a systematic review (SR) is applied. Assessment types include SR, rapid review and critical appraisal. As critical appraisal tools, AMSTAR (A MeaSurement Tool to Assess systematic Reviews), the Cochrane 'Risk of bias' tookl and RoBANS (Risk of Bias for Nonrandomized Studies) are used. RoBANS was developed by the HIRA in 2013 to assess the risk of bias in non-randomized studies. This is institutionalized in the operational regulations for the value assessment of medical devices along with the review of cost-effectiveness of medical devices and their technological innovation, and it is reflected in the state notification from the Ministry of Health and Welfare Examination.
From 2007 to the present, 21 systematic reviews and 74 rapid reviews have been reported, and 142 literature critical appraisals conducted. The EBH reports produced were provided to each committee and used in decision making for review case determination, reimbursement standard setting and improvement, and value assessment of medical devices amongst other items.
EBH reports are very useful to the decision-making process of each committee under the HIRA. In addition, we are in the process of structuring an ’evidence-based decision making process‘ that fits the domestic situation by utilizing EBH reports and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group’s ‘evidence to decision frameworks (EtD frameworks).
Patient or healthcare consumer involvement:
HIRA’s decision making affects the supply and consumption of health care, as a result indirectly influencing patients and consumers.