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J Korean Med Assoc > Volume 62(4); 2019 > Article
Journal of the Korean Medical Association 2019;62(4):231-237.
Published online April 16, 2019.
DOI: https://doi.org/10.5124/jkma.2019.62.4.231   
Essential health care
Sang Moo Lee
Health Insurance Review & Assessment Service, Wonju, Korea. lsmlight@hira.or.kr
Abstract
The term “essential health care” is used as both an absolute concept and a relative concept. In countries with a high level of economic development, the implications of the relative concept of essential health care are generally more important, as the essential medical services included within the absolute concept are usually covered. The definition of essential health technologies as those that should be prioritized in public healthcare from a socioeconomic point of view is crucial for the process of in a timely manner. These determinations should be based on scientifically rigorous, comprehensive, and critical evaluations, including systematic reviews of the literature, and decision-making should proceed through a process of based on medical and socio-economic values. These decision-making processes should be transparent and consistent. In South Korea, the legal standard for decision-making by the health insurance program regarding whether mandates taking into account medical validity, medical, effectiveness, cost-effectiveness, patient cost burden, and social benefits. However, there are a number of committees that make coverage decisions, and there are no guidelines for standardized decision-making methods and procedures; therefore, it is urgently necessary to develop an explicit, detailed and specific decision-making guideline.
Key Words: Patient acceptance of health care, Needs assessment, Evidence-based practice, Health insurance
 


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