The Current coverage expansion policy seeks to provide quality healthcare to all for the high efficient and sustainable healthcare system. Korea health care system continues to improve health and increase life expectancy but experiences the fastest health care spending growth in the OECD countries. We need evidence-based policy changes to improve the value we need from health care for the ageing society.

This study is a national healthcare quality report which gauges progress made in the performance of the health care delivery system. This report is composed of six chapters. The first chapter explains the background and methodology of developing the report. The second chapter understands recent trends on assessing health care system performance including USA NHQDR. The third chapter assesses the performance of health care system by classifying trends and disparities in the access to health care (including timeliness) and in 6 dimensions (effectiveness, patient safety, patient centeredness, care coordination, efficiency, system infrastructure) of quality of care since 2005 to 2016 in terms of 190 measures, which is based on the framework of promoting quality improvement centered health care system reform. The fourth chapter compares the performance of 16 regional health care systems. The fifth chapter estimates expected effects of recent coverage enhancement policies on increasing the financial protection of low income group. The last chapter suggests challenges to improve system performance.

In the access to health care, most measures are being stagnant for the cost and service coverage though achieved 100% population coverage. Most indicators show disparities which is beneficial to the richer groups. the share of Households with the catastrophic expenditure defined as out-of-pocket spending for health care that exceeds a 40% of a household's ability to pay, increased from 3.7% in 2010 to 4.4% in 2015.

The quality of care changes unevenly across different quality dimensions, as most indicators measured in the patient safety dimension have improved the fastest while those of the care coordination dimension have deteriorated. Also, the quality of care varies to some extent across regions. Still, the measures we have at our disposal are not enough to represent the national-level quality of care, especially for patient-centeredness and patient-safety.

There is a clear need for the development of additional data resources which will help to track the quality of care in a well-rounded way. Also, Decreasing income disparities in doing healthier behaviors and rationalizing geographical disparities in system infrastructure should be prioritized for health care policy developers towards a people centered, value based health care system. 

Abstract ········································································································································1

I. Introduction ···········································································································17

  1. Research Background and Purpose ·······································································································19

  2. Research Scope and Methods ·······································································································22

  3. The Framework of Health System Performance Evaluation ·····························································································38

II. Introduction to Health System and Performance Reporting ··································································57

  1. Health System Analysis and Performance Structure ·························································································59

  2. Reporting the Performance of the National Health System ····················································································69

  3. U.S. National Healthcare Quality and Disparities Reports ·····································································73

  4. Yearly Reports on the Performance of Ontario's Health System ······································································82

III. Korea's Health System Performance and the Trends and Gaps of Its Healthcare Quality ·································91

  1. Trends and Gaps in Health Access ·····························································································93

  2. Trends and Gaps in Health Quality ·····························································································113

  3. Health System Performance ·································································································167

IV. Comparison of Local Health Systems' Performance ···································································173

  1. Performance of Local Health Systems: Summary ···················································································175

  2. Comparison of Efficiency Using Amenable Mortality Rates ··········································································245

V. In-depth Analysis: Universal Health Security and the Adequateness of Health Insurance Coverage Enhancing Policy ·····257

  1. Background and Methods ·······································································································259

  2. Results of Analysis ·····················································································································271

  3. Summary and Limitations ················································································································280

VI. Conclusion ·········································································································283

  1. Summary of Results ···················································································································285

  2. Policy Tasks ·····················································································································290

  3. Limitations of Research ················································································································309

References ···············································································································311

Appendices ····················································································································325