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KMID : 1142920190030010133
Public Health Affairs
2019 Volume.3 No. 1 p.133 ~ p.143
Challenges in adopting in-vitro diagnostic tests in the national health insurance coverage: Korean experience of HCV rapid antibody test
Choi Yeon-Mi

Chung Seol-Hee
Abstract
HCV Rapid Antibody Test using Oraquick kit has been included in benefit package of National Health Insurance on July 24th since 2019. It was first introduced in 2012 and one of the items not covered by NHI. We examined the process from market entry to the benefit coverage expansion and foreign cases about whether the tests are covered by health coverage or not and their costs. For this, we reviewed the articles, reports, laws and regulations, and related foreign organizations’ websites’ posted documents. We also analyzed cost data on NHI-uncovered services of the HIRA from 2016 to 2018. Our findings suggest several challenges for policy makers and researchers. First, the criteria and principles for adopting new technology in the NHI coverage has to be reconsidered. Some new technologies are not essential because there are existing technologies which are more cost-effective and substitutable. Second, new pricing mechanism has to be considered for new technologies, especially in-vitro diagnostic test. It is because the proportion of medical device cost is very high in some new technologies including the test. Third, it needs to set explicit criteria for target population and benefit considering both financial sustainability of NHI and promotion of new healthcare technology adoption. Third, it needs to set explicit criteria for target population and benefit considering both financial sustainability of NHI and promotion of new healthcare the technology adoption. Forth, the impact on the NHI budget should be considered. It is expected that the number of technologies and the cost will be increase.
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