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이상수,최현숙,Liesl Strachan 한국보건의료기술평가학회 2015 보건의료기술평가 Vol.3 No.2
Since the year 2000, the reimbursement coverage and pricing rule for medical devices in South Ko- rea has been evolving gradually with the introduction of the ‘Value Appraisal Standard (VAS)’ sys- tem in March 2006 to recognize the premium value of innovative medical devices. Nevertheless, the VAS system has been criticized due to the lack of objectivity and its insufficient operability. Over the last decade, the quest for a more comprehensive, structured and transparent reimbursement coverage decision-making process has prompted research into alternative decision-making frameworks. In this regard, multi-criteria decision analysis (MCDA) arose and has gained more attention as an ap- proach to support healthcare decision-making involving multiple and conflicting criteria. In 2014 the task force initiated by both Ministry of Health and Welfare and Health Insurance Review and As- sessment Service and composed of various stakeholder representatives was formed to improve the re- imbursement coverage and pricing rule by leveraging international practices from foreign countries and to develop the most feasible pricing rule in the current healthcare policy environment. The task force studied the principles, processes and practices for reimbursement coverage and pricing of medi- cal devices in other countries and also deliberated MCDA for improved and fair recognition of the value of innovative medical devices. The consensus for the improved reimbursement coverage and pricing rule with MCDA was reached among the stakeholders and placed into official regulation effec- tive in January 2015. The MCDA application is expected to contribute to better innovation value rec- ognition and also transparent and reasonable operation in the decision-making process.
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Haine Lee,Younghyun Kang,Ji-Hyun Lee,Jae-Eun Myung,Liesl Strachan,Yoko Ishiguro,Sang-Soo Lee 한국보건의료기술평가학회 2020 보건의료기술평가 Vol.8 No.1
The administrative claims datasets refer to the data that occurs when healthcare providers claim ser- vices and items of care rendered to patients from payers. The purpose of this study is to review and compare the characteristics and differences of the administrative claims data in South Korea and Ja- pan. We compared the differences of claims data and examined the utilization of the data based on the hands-on experience of analyzing the data in both countries. The structure of claims data of both countries are comparable since they originated from similar health insurance systems in general. However, there also exist some differences: 1) institution in charge of managing claims data, 2) data access, and 3) data component. First, while the claims data in South Korea are only constructed and operated by National Health Insurance Service and Health Insurance Review and Assessment Ser- vice, those in Japan are constructed not only Ministry of Health, Labor and Welfare but also local governments, academic societies or private entities. Second, in Japan, only government officials or academic societies members can have access to the claims data while other stakeholders can access data that are constructed by private entities but not nationally representative. However, private sector is allowed to access the claims data with public Institutional Review Boards in South Korea. Lastly, unlike Korea, the Diagnosis Procedure Combination database in Japan has a unique characteristic that contains important clinical outcomes and can be analyzed together with claims data. Generating robust research using real-world datasets such as claims, clinical and Electronic Medical Records data is emerging. Based on the review of this study, to enable researchers to perform extensive re- search projects, policies on the use and management of medical big data need to be developed and strengthened.
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