Korea's national health insurance, centering on the National Health Insurance Service (NHIS), is a unique system in which all citizens have to sign in and pay fees to keep their insurance.
The system incorporates not only public healthcare institutions but also private healthcare institutions into the NHIS.
The state insurance agency has a different system for medical procedures and drugs. It applies a positive list system to drugs, covering a portion of medicine and medical supplies with high therapeutic and economic value with insurance.
NHIS applies a negative list system for medical procedures. However, due to health insurance's financial limitation, it uses a hybrid system of a positive system where the government manages the list of both covered and uncovered services for medical procedures. To choose medical procedure receiving reimbursement, it had operated the Standards for Determining and Adjusting a Pending Act since 2000.
However, the nation found problems in the procedures later. For example, the regulations related to medical societies determine the medical service's safety and effectiveness. However, the decision was often delayed as each society had different opinions about the procedure, raising an issue of fairness and objectivity of assessment.
To overcome such obstacles, the National Assembly revised the Medical Service Act to include the New Health Technology Assessment (nHTA) system.
The nHTA aims to protect the public's health rights by systematically and objectively evaluating medical technology's safety and effectiveness.
In detail, the Ministry of Health and Welfare directs the overall nHTA system through the National Evidence-based healthcare Collaborating Agency (NECA).
NECA is in charge of all related works from the division of nHTA, including data collection, processing, analysis for research, committee administration required for handling new health technology assessment, and other related works.
By the unique structure of Korea's health insurance system, if the new medical procedure doesn't pass the nHTA, it cannot enter the health insurance.
Procedures up for review from the nHTA are methods not listed on the Health Insurance Benefit booklet, or technologies and notification of the evaluation result for safety/effectiveness of new health technology.
Specifically, technologies that have one or more change of any one of the purposes of use, target, and method compared to the conventional technology listed in the health insurance can apply for the nHTA process.
However, the nHTA program does not include non-life-threatening medical treatments for illnesses, such as cosmetic surgery, eye correction surgery, and physical examination, as the treatments are seen as non-reimbursed by the national health insurance.
“NECA sees nHTA as a pre-verification system for medical technology,” said Kim Jin-ho, director of nHTA division at NECA “A medical technology developed with good intentions does not necessarily bring good results.”
Therefore, even if it has been developed with good intentions, it is important to prove what medical procedure showed objective results scientifically, Kim added.
Kim stressed that the agency conducts its evaluation based on the value that the most scientific technologies will be most ethical.