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KMID : 1142920180020010017
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Public Health Affairs
2018 Volume.2 No. 1 p.17 ~ p.27
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Moon Care: strategies and challenges
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Kim Yoon
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Abstract
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Improving financial risk protection in National Health Insurance (NHI) is essential to ensure people's access to health care services and protect them from medical bankruptcy. The previous government 's initiatives to enhance the benefit coverage of the NHI and improve financial risk protection have not been successful due to the balloon effect of non-covered services. MoonCare’s two key strategies for preventing the balloon effect were to introduce the preliminary benefit scheme (PBS) which converts all the medically essential non-covered services to be covered in a short period of time and to raise the fee of covered services to compensate financial loss of hospitals and clinics resulting from the benefit expansion. In order for MoonCare to be successful, the PBS should be systematically designed and implemented considering that it has two components such as the coverage with evidence development (CED) and value-based insurance design (VBID). Also, the fee should be increased in a selective manner to reduce the reimbursement imbalance across clinical areas and to strengthen the delivery system. Furthermore, the health policies closely aligned with the implementation of MoonCare should be reformed simultaneously. The existing claims review system should be transformed to peer review system based on the medical record review. Also, the delivery system should be strengthened so as to prevent the large hospitals from seeing more non-serious patients. To prevent the balloon effect, the use of non-covered services should be monitored and controlled and also, the new medical technology appraisal system should be also improved to systematically manage the PBS scheme.
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KEYWORD
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MoonCare, strategy, challenge
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