The Republic of Korea
2021 HIRA International Symposium and Training Course
The Korea National Health Insurance (NHI) covers nearly 97% of population with all essential medical services. Health Insurance Review and Assessment Service (HIRA) in Korea is a public institution under the Ministry of Health and Welfare and manages healthcare expenditure (Annual medical fee: USD 81 billion, as of 2019) for the NHI. HIRA prioritizes service quality and patient safety and ultimately pursues the value-based healthcare purchasing to ensure reasonable spending on the healthcare. One of the main functions of HIRA is claims review. Also, we assess the quality of care, detect fraudulent claims, manage the resource data, and provide technical support for benefit determination. All of these activities are done efficiently by using highly-advanced digitalized system and Big Data management (5.4PB). HIRA’s ICT based NHI management system has been recognized by many international institutions as well as many countries. HIRA has been a role model for many nations who want to build an effective and efficient NHI system. Every year more than 200 experts and public officers from over 30 countries visit HIRA to learn about Korean healthcare and HIRA system.