Setting national priorities for quality assessment of health care services in Korea

Abstract

To identify target services and determine national priorities among those services identified for a national quality assessment program of the Health Insurance Review Agency (HIRA) in Korea. Target services were identified from published sources addressing quality problems, various quality-monitoring programs in other countries, suggestions from 26 medical specialty associations in Korea, and frequently reported consumer claims. Three steps were involved in the prioritization decision: (i) development of a set of priority criteria; (ii) expert panel survey to evaluate the extent to which individual services satisfy each of the priority criteria and to calculate mean priority ratings for individual services; and (iii) formation of four levels of priority groups-top, high-middle, middle, and low-according to the allocated priority ratings. Five priority criteria were selected: "burden of the condition", "seriousness of the quality problem", "interest and demand of society", "acceptability", and "the feasibility of quality assessment". Among the 57 services identified as targets for the national quality assessment program, 10 were selected as having a top priority for quality assessment because of their high feasibility rating. These are: cardiac surgery; cataract surgery; tonsillectomy; appendectomy; tooth extraction; usage of albumin/globulin products; treatments for hypertension, pneumonia, and acute upper respiratory infection; and services provided by clinical laboratory centers. The priority services identified from the studies will assist the HIRA in selecting target services and implementing the national assessment program.