| 건강보험심사평가원 | |
| Native Name A: | 건강보험심사평가원 健康保險審査評價院 |
| Jurisdiction: | Government of South Korea |
| Headquarters: | Wonju, Gangwon Province, South Korea |
| Chief1 Name: | Kim Sunmin |
| Chief1 Position: | President |
| Parent Department: | Ministry of Health and Welfare |
| Website: | http://www.hira.or.kr/eng/main.do |
The Health Insurance Review and Assessment Service - HIRA in short - is a government agency under Ministry of Health and Welfare responsible for claims review and quality assessment of the National Health Insurance.[1] Since its foundation, its role has expanded as it has become a specialised agency with delegated powers related to health insurance and healthcare from the Ministry.[2] Its head with fixed 3 year term is nominated by the Minister upon the recommendations from nomination committee and appointed by the President.[3] [4]
It has its headquarters in Wonju and 10 branch offices across the nation.[5] [6]
Health Insurance Review & Assessment Service (HIRA) ensures to build a sustainable and high-performing healthcare system in Korea.
HIRA collects and connects the health data across the country and then utilizes data for further use to create values in health. HIRA shares its knowledge and experiences with international communities to bring Universal Health Coverage to the world.
• Design and implement the healthcare provider payment systems
• Design the health benefits package
• Conduct the claims review to evaluate healthcare costs
• Re-review claims and providers via a follow-up review and on-site investigation
• Use Quality Assessment to improve quality of care
• Encourage providers to take more steps toward quality improvement
• Designate tertiary hospitals with quality assessment results
• Collect, Connect, and Utilize nationwide data in healthcare
• Play a key role in creating added value
- Drug Management (KPIS / DUR)
- Health Resources Management
- Healthcare Utilization Monitoring Dashboard
• Collaborate with various international organizations
• Provide consultation and capacity-building programs
- Expert Consulting
- Capacity Building Program
Building off of the MERS crisis in 2015, laws and systems were put in place to rapidly respond to the threat of emerging epidemic outbreaks. HIRA utilized tools and skills that enable a rapid and flexible approach to dealing with COVID-19.
With data from patients and providers nationwide, HIRA contributes to preventing spread, detecting and treating cases early, and responding quickly to the surge capacity of the healthcare system.
HIRA ICT system is connected with all healthcare facilities and pharmacies across the country for claims and reimbursement purposes. HIRA has widened the use of this interconnected system piece-bypiece over the last several decades, developing it into a multi-functional network. HIRA have taken full advantage of the existing systems and can adapt their functionality swiftly according what is needed during an outbreak.
- Detection of high-risk groups using DUR/ITS
- Expanding health benefits package rapidly
- Responding quickly to surge capacity through resource reallocation
- Stabilizing the protective face mask supply
- “National Safe Hospital” designation (COVID-19 Protection Hospital)
- National COVID-19 Patient Data Repository
- COVID-19 Global Research Collaboration Platform
Source:[7]