ABSTRACT
The South Korean healthcare system has two components: The National Health Insurance (NHI) and Medical Aid (MA). NHI is a social insurance system that covers all citizens. Implementation of reviews and fee schedules is handled by the Health Insurance Review and Assessment Service (HIRA). MA provides healthcare to lower-income groups, which are 3 percent of the population. The South Korean positive list was established in 2006 and provides reimbursement for drugs that offer proven clinical benefit and demonstrate cost-effectiveness. Following the reimbursement advice from HIRA, the pharmaceutical company can start price negotiations with National Health Insurance Service (NHIS). Cost-effectiveness criteria usually are a starting point rather than an indication of acceptable price, as the NHIS usually tries to extract additional concessions. Following the English Patient Access Scheme model, the South Korean government started to engage in risk-sharing deals with pharmaceutical companies beginning in December 2013.
