Health insurer to boost clinical autonomy at top-rated hospitals

The Health Insurance Review and Assessment Service (HIRA) said it will accept applications from Wednesday through Nov. 24 from hospitals seeking to join its autonomous analytical review pilot program covering cerebrovascular disease and acute myocardial infarction.

The autonomous analytical review system is designed to guarantee clinical expertise and autonomy grounded in medical evidence. It targets hospitals that demonstrate high standards in both medical billing review and quality management.

Eligible institutions are tertiary and general hospitals accredited by the Korea Institute for Healthcare Accreditation. For the cerebrovascular disease category, applicants must have received a top rating in the acute stroke appropriateness assessment or be designated as a regional cardiovascular and cerebrovascular disease center.

For the acute myocardial infarction category, qualifying institutions must meet all three of the following criteria: at least two board-certified cardiologists who perform percutaneous coronary intervention (PCI), a minimum of 150 PCI procedures annually, and a first- or second-tier rating in the patient safety, medical quality, public service, and care delivery support categories of the medical quality assessment — or designation as a regional cardiovascular and cerebrovascular disease center.

Selected institutions will be chosen through a comprehensive review of submitted materials and a deliberation committee process, and will participate in the pilot program for one year beginning in January 2027.

Institutions wishing to apply must submit a participation application, an operations plan and a participation agreement through HIRA's healthcare provider portal by 6 p.m. on Nov. 24.

HIRA President Hong Seung-kwon said the program is expected to encourage hospitals to manage medical quality autonomously and promote appropriate care, contributing to improved healthcare quality and public health. "We will continue working to ensure the public receives higher-quality medical services," Hong said.