Health Authorities to Assess Appropriateness of Blood Transfusions and Outpatient Depression Treatments

An image of a knee replacement surgery being performed by an AI robot

[Asia Economy Reporter Choi Dae-yeol] Starting this year, health authorities will also examine whether proper insurance benefits are being provided for blood transfusions and outpatient treatment for depression.

The Ministry of Health and Welfare and the Health Insurance Review and Assessment Service disclosed the plan for this year's appropriateness evaluation of medical benefits on the 14th. This evaluation is a procedure to assess whether medical services such as consultations and surgeries provided under health insurance were appropriate from medical and cost-effectiveness perspectives. Since beginning with the evaluation of antibiotic prescription rates in 2001, the scope of evaluation has expanded to include acute and chronic diseases, patient experience, and small to medium-sized hospitals.

The appropriateness evaluation for blood transfusions was newly established this year to enhance patient safety. If transfusions are not properly conducted, they can cause serious side effects. The Ministry of Health and Welfare reported that the domestic blood usage is excessively high compared to other countries, indicating the need for proper management of blood use in medical institutions. In the second half of this year, the evaluation will focus on total knee replacement surgeries, which involve frequent transfusions, and gradually expand to other target surgeries. The transfusion rate for this surgery in Korea is 78%, which is several times higher than in the United States or the United Kingdom (each 8%) and Australia (14%).

Mental health-related evaluations had been limited to inpatient care, but from now on, outpatient treatment for depression will also be evaluated. This measure considers that most depression patients receive outpatient care. Additionally, as the use of imaging tests such as computed tomography (CT) continues to increase and concerns about patient safety from medical radiation exposure grow, a preliminary evaluation of the overall safety management system in endoscopy rooms will be conducted to consider introducing a full evaluation in the future.

To strengthen the treatment functions of long-term care hospitals, new indicators related to treatment outcomes, such as community reintegration rates, will be created. The evaluation period will also be extended from the existing 3 months to 6 months. Considering last year's first tuberculosis evaluation results, which showed many new tuberculosis patients aged 70 or older, long-term care hospitals with many elderly patients will be included starting this year. The evaluation of prophylactic antibiotic use in surgeries will expand this year to include fracture surgeries, pacemaker implantations, appendectomies, and vascular surgeries. In addition to acute upper respiratory infections, the evaluation of antibiotic prescription rates will be extended to acute bronchitis and acute bronchiolitis, which are acute lower respiratory infections. The previously separate evaluation of antibiotic use for acute otitis media in infants and young children will be integrated for review.

Considering that appropriateness evaluations are utilized in various medical-related evaluation systems, a plan has been established to gradually build a comprehensive evaluation information management system. Consulting, including education and counseling, will also be provided to institutions that need to improve the level of medical services.

This content was produced with the assistance of AI translation services.