J Korean Med Assoc.  2022 Dec;65(12):841-849. 10.5124/jkma.2022.65.12.841.

Physicians’ perception of the reform of the review and assessment system of national health insurance reimbursement claims

• Lee JC
• Kim KH

• KMID: 2537218
• DOI: http://doi.org/10.5124/jkma.2022.65.12.841

Abstract

Background
The Korean government has been promoting the reform of the review and assessment system of national health insurance reimbursement claims. The aim of this study was to find out physicians’ perception and evaluation of the health insurance review and assessment system and present the direction for the government’s reform plan.
Methods
The 2020 Korean Physician Survey questionnaire was sent to 57,714 members of the Korean Medical Association from November 19, 2020 to January 10, 2021. A total of 6,507 physicians (11.5%) responded; of these, the responses of 4,454, including the self-employed and employed, professors, and fellows, were included for analysis. The respondents’ perception of the current health insurance review system and of the government’s reform plan were analyzed.
Results
It was found that 84.2% of the respondents evaluated the current health insurance review system negatively—particularly in terms of medical autonomy, transparency of the review standards, the standard development and application process, and the post-review adjustment process. Furthermore, only 0.7% of the respondents evaluated the government’s reform plan positively—particularly, the utilization of clinical practice guidelines for review standards, introduction of the professional review committee, and expansion of the link between the review and assessment system.
Conclusion
Policymakers should understand physicians’ perception and evaluation of the health insurance review system. In addition, the reform plan should be thoroughly communicated to physicians.

Keyword

Health insurance; Health insurance reimbursement; Physicians; Healthcare policy; Republic of Korea; 건강보험; 건강보험급여; 의사; 보건의료정책; 대한민국