How To Get Universal Health Insurance In Korea

Transcription

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2 KOICA s Intervention in moving forwards UHC Young Ran Kim

3 1. UHC in Korea - History and SWOTs in Korean Health Insurance 2. KOICA s intervention in moving forwards UHC

4 1. Introduction Korea s Experience Korea's transformation from extreme poverty to an OECD member Mounting calls from the international community to share extensively experience more widely Quote by James Gustave Speth, Former Administrator of UNDP "The Republic of Korea is a prime example of a country that has climbed out of poverty and rapidly joined the ranks of the developed countries...korea is a solid model for many other countries to follow...we have common goals and a common The Republic of Korea is a prime example of a country that has climbed out of poverty and rapidly joined the ranks of the developed countries...korea is a solid model for many other countries to follow.

5 Korea Health Insurance Brief information about Korea Health Insurance

6 History of National Health Insurance in Korea Enacted Medical Insurance acts Start Medical Insurance Program for the employees in big companies(500+) Start Local Medical Insurance in rural area Start Local Medical Insurance in urban area Achieving National health insurance only in 12 years

7 Major Development of Health Insurance in Korea Year Major Development Compulsory health insurance implemented for large work places with 500 employees or more Government employees, private school teachers and Employees are compulsory insured Expanded coverage to employees with more than 300 employees Population Coverage(%) Per Capita GNP (US$) , , Expanded to work places with at least 100 employees , Expanded to work places with at least 16 employees or more ,002 X Insurance coverage includes oriental medicine - 3, Rural residents compulsory insured , Urban residents compulsory insured Coverage includes drugs dispensed at pharmacy ,994

8 History of National Health Insurance in Korea Enacted National Health Insurance Acts Multiple payers were merged into a single payer - National Health Insurance Corporation(NHIC) - Health Insurance Review & Assessment Service(HIRA) was established for independent medical fees review

9 NHI Scheme in Korea: flow chart Ministry of Health & Welfare NHIS The Single Payer Review & Assessment Results Review & Assessment Results Claims Healthcare organizations Health Checkups Request for Verification of Fee & Benefit Coverage Provision of Benefit and Fee Information Co-payment Contribution (Premium): 5.89% The Insured Health Care Services Reimbursement

10 SWOT analysis of Korea s Intervention

11 Strength Local Health Insurance National Health Insurance Experience Law and Institution, Data management System From local health insurance to national health insurance, Korea has successful experience in establishing law, institution and data manage ment system

12 Strength Korea has sufficient health insurance specialists in the academe and organizations Korea has well-developed data management system and IT capability review and evaluation about health insurance as well as managing payment system

13 Strength (Source: World Economic Forum, The Global Information Technology Report, 2013)

14 UHC for Global Happiness Weakness Even though Korea possesses sufficient organization and people that are specialized in health insurance, we are lack of experiences working at partner countries (Lack of ODA experience)

15 Opportunity When a lot of international organizations, assistance agenci es and NGOs discuss health insurance, Korea is considered as a representing case It is considered as prime example of a country which Obam a, President of US wants to replicate its Health System.

16 Threat Political, economic and socio-cultural environment of partn er countries are different from those of Korea promoting n ational health insurance. (Which means Korea should not su pport the health insurance business depending only at Korea 's experience) Global economic crisis : (Decrease of health related ODA support) Political conditions of partner countries

17 2. KOICA Health Strategy Our Goal : KOICA will contribute toward strengthening capacity of partner countries to provide essential health services and a safety net for the most destitute.

18 KOICA Health Sector Projects ( ) Percentage Total Health From 2000 to 2010, KOICA continued to increase support in partner countries as well as support in the field of health. Health-related support represents 20 percent of KOICA s total budget, which in 2010 stood at about $80 million

19 KOICA Health strategy Strengthening of Health Systems Strengthening Capacity of Human Resource in Health Sector Strengthening Institutional and Financial Capacity of Health System Strengthening Accessibility for Health Care Service

20 Strategic Objectives and Core Program Strengthening Health Financing capacity including Health Insurance System Strengthening Health Information System Strengthening Health Policy Planning and Management Capacity Strengthening Institutional and Financial Capacity of Health System

21 Strengthening Institutional and Financial Capacity of Health System It is possible to obtain sustainability for the health program only when it is Legally Functionally Institutionally established and when it operates on its own capacity

22 Out of pocket expenditure on health as a Percentage of Total expenditure on Health South Korea (42.7) Nepal (60.7) Philippines (66.7) Cambodia (77.6) Vietnam (59.6)

23 KOICA s Upcoming projects Project Title and Scope Nepal Health Insurance Expansion Project ( /USD 4.5 million) Cambodia Health Sector Support Program for Health Equity Fund ( / USD 5 million) Philippine National E-Health Strengthening Project ( / USD 5 million)

24 Health System Strengthening Program Nepal Health Insurance Nepal Community Based Health Insurance Project Purpose : - Develop health insurance model appropriate for Nepal Project contents : - Establishing community health insurance model in 6 pilot area - Health Insurance personnel strengthening - Health Insurance Capacity Building Project outcome : - Establishing basis for national health insurance scale-up

25 Cambodia Health Sector Support Program Cambodia Health Sector Support Project Purpose : - Develop health insurance model appropriate for Cambodia to achieve MDGs goals (Re duce child mortality, improve maternal health) - Achieve Universal health care(uhc) in long term Project contents : - To support long term strategy(hsp2), 7 partner organizations are working together with the government - Health Insurance Capacity Building : Support regional hospitals to implement Health Equity Fund (HEF) Project outcome : Improvement in clinical knowledge and technology on the basis of Cambodia s health worker developing plan(hwdp )

26 Health System Strengthening Program Philippines Health Information System Interoperable Health Information System for CHD 4A-CALABARZON Implementing Agency : DOH Information Management Service Implementation Period : 5 years ( ) Total Project Cost : USD 5 Million Project Description : Establishment of an integrated Electronic Health Record (iehr) that will serve as the regional model for the successful implementation of an integrated patient centered health care delivery system.

27 Continuous Health System Strengthening Program Philippines Health Information System Project outcome : - Government hospitals trained in Hospital Operations and Management Information System-Medical Record System - RHUs and BHSs trained in Clinic Information System - Medical Record System - Health facilities uploading data to DOH Regional Office and Central Office - Establishment of Data Center for Integrated e-health Record (iehr) - IT support personnel trained in System Administration, Database Management and Administration, National Health Data Dictionary, Unified Health Management Information System, etc. -Program managers and data users trained in National Health Data Dictionary, Unified Health Management Information, iehr, Business Intelligence

28 Thank you UHC for Global Happiness