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Prof.
Hae Sun Suh, Mpharm, MA,
PhD Pusan
National University, Korea To give you an overview of the
Korean health care system, the entire population of Korea is covered by
national health insurance starting in 1989. But they have to pay out of
pocket. People are aware of the cost that they are paying when they are using
the healthcare services. Basically in Korea, the payment system is pay for
service. It is categorized by the types of drugs; medical supplies, including
diagnostic and devices; and health care procedures. For the drugs, we have a list of
drugs that are covered in the health insurance scheme. In order to get to
that list, pharmaceutical companies have to submit the cost effectiveness
data or HTA data to the agency. We have the reimbursement receiving prices.
If the drugs sell in the market below that sitting price, then that actual
price is going to be reimbursed. But that price cannot go above the sitting
prices. For the medical supplies, we have the list of what is covered, and
what isn't. For the procedures we also have the same list. Drugs and medical supplies, these
two have different track when they seek government's approval. The drug and
medical supplies need to get the approval from the Ministry of food and drug
safety. For medical procedures, however, we can't give the approval if they
aren't combined with drugs and/or medical supplies. After the approval, they
have to get the reimbursement so that the patient can use it. We adopted positive listing system
in 2006. Pharmaceutical companies are allowed to apply for the coverage if
they want to. All of these are based on data-driven decision process, where
HTA plays a key role. If they want to get the coverage for new drugs, the
company has to apply for it first and then HIRA will give a debt to view in
term of the clinical benefit, feasibility, and the cost effectiveness. There
will be reinvestment appraisal and then they going to make decision whether
to list the drugs or not. Then it goes to another government agency and they
proceed to the price negotiation. During the economic evaluation,
the new drugs will be compared to existing drugs. They compare the cost and
the outcomes. The company has to produce the evidence to keep going on with
that reimbursement. For the medical procedures
assessment process, the procedures will be evaluated alongside the medical
devices and/or the drugs, in order to obtain the government's approval. All
of these steps are based on the HTA guidelines. We have been using HTA in
health-related decision making process, and also, we try to make more
medication accessible for all patients. |
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