The development of innovative health technologies is very important as they can extend human life by expanding the scope of medicine, improving the quality of life for patients, and providing the opportunity to promote new industries.
New health technologies can help Korea advance health services and ICT use, develop precision medicine, and pioneer a new medical field.
Innovative health technologies have a significant impact on the industry as they can help Korea avoid competition with medically advanced countries and find a niche market.
In order for innovative medical technologies to be used in the clinical environment, however, they must receive legal approval and the benefits of health insurance. Refunds are only allowed for people who can demonstrate both safety and effectiveness.
However, proving the profitability of innovative health technology in a short period of time is not easy.
The bigger problem is that Korea’s unified national health insurance program makes it difficult for developers to come up with evidence using innovative health technology. As a result, the developer must overcome many obstacles.
With that in mind, the recently introduced New Health Technology Assessment (nHTA) system is a step forward for the Korean healthcare system. The system enables the early use of innovative health technology for patient care if it meets certain requirements for innovation and potential.
Applying innovative health technology to clinical care is an issue for Korea and many other countries. The US provides conditional insurance benefits such as Coverage with Evidence Development (CED) for research that provides evidence to determine coverage by public insurance tariffs and protection by private insurance companies. The Center for Medicare and Medicaid Services (CMS), which sets reimbursement rates in the United States, helps people transparently review the relevant articles and circumstances on their website.
Similar to Korea, Japan supports new medical technologies that are not covered by statutory health insurance through a system called “Advanced Medicine”. This system is implemented conditionally, as every medical technology has certain standards and only medical institutions that meet the requirements can use it. Since Japan recognizes its use in combination with statutory health insurance, the patient only pays the cost of advanced medicine. Other medical costs are covered by the statutory health insurance.
In addition, the UK has been running the Accelerated Access Review (AAR) since 2014 to give patients easy access to innovative medicine. When innovative medical technology has little clinical evidence, the Clinical Commissioning Groups decide whether they should be covered by public insurance.
France ran a pilot project on percutaneous aortic valve placement, innovative medical technology with little clinical evidence, in 2007 and introduced a conditional reimbursement system in 2009. By revising the system in 2015, France enabled innovative health technology for patients if its clinical impact is medium or higher than the existing technology.
These examples show that many countries are looking for ways to quickly and safely apply innovative health technologies to patient care. The decisive factor is how cost-effectiveness can be demonstrated.
However, the Korean health insurance program is conservative in providing reimbursement. As a result, the government finds it difficult to provide even limited reimbursement for new health technologies that have passed regulatory review. So in most cases the technology is not covered by insurance and the patient pays the costs. In this case, the patient will have to spend the money to become a subject whose effectiveness is only vaguely proven.
The doctor also faces a dilemma: it is difficult for him to aggressively recommend innovative medical technology to the patient. To overcome this problem, the government should support approved innovative health technologies used in clinical trials to produce clinical evidence.
Running stable health insurance funding and developing innovative medical technologies using AI or 3D printing may not be compatible. In particular, the use of new health technologies without proof of effectiveness with the patients’ money could cause ethical and equity problems and hinder the development of innovative medical technology.
However, the state can only achieve stability in health insurance expenditure if it pursues many goals simultaneously and cost efficiency – developing alternative technologies, eliminating the monopoly of medical technology and setting in motion healthy competition, offering patients or doctors comfort, improving the quality of life for patients and establishing more innovative ones medical technology ecosystems.
Therefore, the cost of using approved innovative health technologies in clinical care should be covered by a separate government grant rather than health insurance.
One possibility is to create a special subsidy, as well as government subsidies for the purchase of a low-emission vehicle in order to increase the use of electric cars. Or the support could be provided as a government R&D project.
Korea adopted the nHTA system the hard way and more technologies are passing the nHTA review. In order to revive this system and the new technology, the development of the technology and its application in the clinical setting should be ethical and sustainable.