Essential health care

Article information

J Korean Med Assoc. 2019;62(4):231-237
Publication date (electronic) : 2019 April 11
doi : https://doi.org/10.5124/jkma.2019.62.4.231
Health Insurance Review & Assessment Service, Wonju, Korea.
Corresponding author: Sang Moo Lee. lsmlight@hira.or.kr
Received 2019 February 14; Accepted 2019 March 22.

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.

Acknowledgement

This article is written at the request of Korean Medical Association Policy and is not an official opinion of Health Insurance Review and Assessment Service.

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Article information Continued

Figure 1

Universal health coverage and essential health care services. Adapted from Boerma T et al. Monitoring progress towards universal health coverage at country and global levels: framework, measures and targets. Geneva: World Health Organization; 2014 [4].

Figure 2

Schematic figure of concept for relatively and absolutely essential healthcare.

Figure 3

Decision framework for the coverage of new health technologies in the national health insurance. OOP, out of pocket; CED, coverage with evidence development. Adapted from Yun YJ, et al. Evid Value Healthcare 2017;3:78-83 [13].