韩国医疗保险质量评估的经验及对我国的借鉴

Experiences from Quality Assessment by Insurance Agency in South Korea and Lessons for China

目的:通过梳理和分析韩国医疗保险监管部门在质量评估方面的成熟经验,为进一步提高我国医疗服务质量和提升医保监管能力提供政策建议。方法:采用定性研究方法,主要为文献综述和定性访谈。结果与结论:韩国医保监管部门开展质量评估时从项目评价开始逐渐扩大评价范围、实施质量评估采用标准化路径,并且充分利用评估结果进行循证决策,值得我国借鉴。

Objective:By reviewing and analyzing the quality assessment(QA) experience from the health insurance agency of South Korea,it aimed to provide policy recommendations on improving health service quality and insurance supervision for China.Methods:Qualitative research methods,including literature review and qualitative interviews,were conducted.Results and Conclusions:The quality assessment in Korea started from small number of projects and then scaled up to wider scope,followed a standardized quality assessment path and used the results of QA to inform insurance policy.These were applicable experiences for the QA in China.