Healthcare Service Information Smartphone Application
Health Insurance Review & Assessment

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
•Good health and access to quality health services are a basic human need. They are critical to individual well-being and to sustain a productive society. In South Korea, as in much of the world, there is a tremendous knowledge gap amongst the general population regarding their own health and healthcare services. •When a person falls ills or requires urgent care, she does not have the time, resources, or expertise to understand her own health condition and to research which healthcare provider will offer the best service. •Typically, patients are entirely dependent on the healthcare system and their own basic research. Moreover, they are often too intimidated to ask questions to healthcare providers and unable to challenge their authority. Vulnerable groups who often require more healthcare services such as people with disabilities, senior citizens, and the poor are often even more ill-equipped to make these decisions. •Health service is often required urgently and as such citizens have to make immediate decisions with little information available at that moment other than from the health provider or close family and friends. •In 2009, a Korean Consumer Research Center survey of the general public found that people wanted better information regarding basic aspects of healthcare services, including location of closest health care facilities (25.7%), qualifications of providers and quality of service (22.7%), average waiting times for appointments (9.9%), reputation of service providers (16.0%), and healthcare fees (1.8%). •The survey further found that most people relied on basic web searches or “word-of-mouth” approaches to guide their choice of healthcare services. •While reputation is important, there was little objective evidence regarding appropriateness or quality of care guiding these decisions. •In fact, in Korea, the general public tends to favor big name tertiary hospitals, with the feeling that “Bigger is better.” However, there are many other facilities that offer quality care that may be more appropriate and convenient to the individual. •From the perspective of the citizen, the information vacuum can be broken down to 4 major types of questions: *Where is the closest provider that will treat my condition (specialized services, if necessary)? *Where can I get the highest quality service? *How can I learn more information about my condition, treatment, and tests that I will receive? * How much will it cost, is it covered by insurance, and am I paying the fair amount? •Established in 2000, the Health Insurance Review and Assessment Agency (HIRA) is an important resource for citizens to find out more information about the country’s healthcare services. •However, most citizens were not aware of the full spectrum of the resources and tools at HIRA available to help make these decisions. •Subsequent to the strong appeal for better information by consumer advocacy groups and the general public, HIRA was challenged to devise a solution.

B. Strategic Approach

 2. What was the solution?
In 2010, consumer advocacy groups and HIRA leadership came to consensus that that no less than a paradigm shift was warranted where citizens who were previously uninformed, ill-equipped, or intimidated would be encouraged and empowered to make better decisions regarding their healthcare. The overall strategic aims of this initiative were to: •Empower citizens to make better healthcare decisions with comprehensive and accurate information. •Provide real-time information to exploit the critical window of opportunity when patients need care on an urgent basis seek healthcare information. •Improve access to information and increase demand by providing an easy-to-use, appealing, and convenient service. The target audience was the general Korean public, but special attention was paid to people with disabilities and the elderly. In South Korea, with one of the highest percentage of smartphone users in the world, the answer clearly pointed to the development of a smart device application that could provide comprehensive easy-to-use information that was available in real-time. HIRA leadership convened major stakeholders in early 2010 to set forth a fast-track initiative to develop this application, driven by the motto “Better, faster.” By fall of 2010, the first version of the HIRA application was launched. In 2011, the application had been downloaded 109,000 times and has been increasing every year to 184,966 downloads in 2013. THE HIRA SERIES OF SMART APPLICATIONS: CLOSING THE KNOWLEDGE GAP HIRA provides an integrated series of four applications that provide citizens real-time and accurate general and even personalized information regarding key elements on their health and health services. These applications present data in meaningful ways (e.g. searchable, aggregate, through maps) that can be easily understood and used by citizens. Voice-activated and voice-reading features were specifically designed for the elderly, visually impaired and disabled to improve their access. The applications address the four major areas of desired health information: 1. Where is the closest place that will treat my condition? - Information on over 85,000 health facilities – nearly all in Korea. -GPS-enabled location service to identify closest healthcare facility, including type of hospital, departments, specialized clinics or facilities. - GPS location service to identify closest pharmacies. - GPS location service of facilities with specific medical diagnostics or devices - GPS location of closest facilities offering emergency care. -All these features identify closest hospital, link to a map, and button to directly call the healthcare facility. 2. How can I get the highest quality service? -Gives HIRA quality rating (1-4 scale) of healthcare facility overall -Gives HIRA rating of healthcare facility by specialty -Gives HIRA rating on how experienced a healthcare facility is in a particular health service 3. How can I learn more information about my condition, treatment, and tests that I will receive? -Information pages related to common health conditions, medical procedures, and devices. -Citizens can check their specific prescription history, specific drugs and safety warnings. - A monthly mobile webzine “Health” features important health topics for the general public -Informational videos on health conditions and explanation of HIRA’s services. 4. How much will it cost, is it covered by insurance, and am I paying the fair amount? -Description of how fees for common procedures and services are set, the range of costs, and the maximum fee allowed by the government. -Citizens can scan the receipt of their hospital bill with their smart device to submit verification request that hospital bill was fair and appropriate.

 3. How did the initiative solve the problem and improve people’s lives?
Although smartphone applications are popular, surveys found that public sector applications were rated low in quality and convenience. The satisfaction score was even lower among populations with disabilities. By presenting the most useful health service information from the perspective of the citizen (not the public agency), HIRA and stakeholders developed an application that is useful and easy-to-use. As of 2014, the HIRA application received 3 awards and is rated 4 stars or above by users in the application stores. The creative and innovative approaches include: •A very active and participatory role of consumers groups and citizens, including the elderly •A competition is held annually to solicit ideas from the general public for improvements to the HIRA application. •Voice-activation features for visually-impaired and elderly who often require health services the most. •Up-to-date and real-time to take advantage of the window of opportunity to provide health service information. •Technical, financial, and training support provided by a public-private partnership with SK telecom •Personalized emergency call function: Users can enter their personal information: age/gender, disease conditions (epilepsy), blood type, organ donor. During an emergency, the person can push an emergency button that will contact responders with their precise GPS location and their health history.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Phase 1: Multi-stakeholder consultations to inform initiative strategy and implementation Early 2010 -Health Service Advisory Board is formed by HIRA to respond to public demand for better information to healthcare services. -Board convenes consultations with consumer advocacy groups, relevant government agencies, major Korean telecommunication companies, healthcare providers, and academic experts. -Consultations lead to agreement that improved public service is needed to empower citizens to make better healthcare decisions. -HIRA leadership decides to launch “HIRA application” initiative on a fast-track timeline. Phase 2: Development of HIRA Application July 2010 – HIRA recruits university IT students to bring creative and consumer-oriented ideas for the development of the application. July 2010 – “HIRA application” Development Committee is formed. This working group is comprised of approximately 70 members including HIRA personnel, the university students, SK telecom, consumer advocacy groups, and target application users (e.g. elderly women). Committee meets on weekly basis to assess progress of HIRA application development and provide feedback. March 2011 – HIRA forms a public-private partnership with SK Telecom to receive technical, financial, and human resource support in HIRA application development. Late 2010-2011 – Strategy: Building information base for HIRA application. HIRA application development committee begins review, collection, and selection of key health information and features for first version of application and lays out strategy to include further information in subsequent versions. This also entails a transfer of available web services to the mobile device format as well as future enhancements. Phase 3: Launch of HIRA Application version 1 October 2010 – HIRA application version 1 is launched with two features: 1) The HIRA Healthcare Facility Application: This first version includes comprehensive information on 85,000 hospitals and pharmacies in Korea and GPS-location services and emergency call button that alerts responders of emergency and provides basic health information of citizen. 2) “Health” webzine: This application is the electronic version of the previously paper-based health information magazine for the lay audience. It provides a visually appealing and easy-to-understand information on popular and important health topics. December 2010 – “Health” webzine receives first place award for 2010 Web Award Korea competition. First time public sector wins award in this competition. 2010-2011: -Consumer Monitoring Group meets every month to discuss customer satisfaction, provide feedback, and suggest improvements to application, - HIRA application development committee receives feedback from Monitoring group, customer satisfaction ratings, and its own member experiences to continue to improve application. -HIRA launches annual competition to solicit innovative ideas from general public for improvements and new features to HIRA application. Phase 4: Upgrades and Additional Features for HIRA applications January 2011: - Strategic Plan for Integration of Comprehensive Health Information is completed. This plan lays out strategy for the stepwise integration of the vast amount of information and resources at HIRA. March 2011: Version 2.0 is launched. New features include: oPatients can check personal drug history oImproved GPS-location services to more accurately pinpoint distance to hospitals. oAndroid version introduced in December thereby expanding user base as more consumers shift to Samsung phones. -SKT telecom provides investment in HIRA Hospital information project by fully supporting version 2.0 upgrade -October 2012 – HIRA application wins 1st prize for Korean Mobile Award for public sector app category. -November 2012 – HIRA application wins 1st prize Korean Mobile App Award for public sector app category. January 2013: Version 3.0 is launched. New features include: - Application now incorporates comprehensive HIRA information as detailed in Strategic Plan. - Version 3.0 focuses on reflecting citizen feedback. - Includes Medical Fee Review service for personalized hospital bill assessment. - Important security updates to protect patient information

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
There were several committees involved in the design and implementation of this initiative. The main groups were the 1) Health Advisory Board which provided initial recommendations, 2) the HIRA app task force which ensured that key HIRA services were reflected in the application 3) the HIRA application development committee that guided the development of the application at the working level, 4) the Consumer Monitoring Group that provided customer satisfaction feedback and suggestions for enhancements, and 5) the Patient Advocacy group composed of consumer groups and healthcare associations. The specific stakeholders were: Public Institutions: HIRA – convened the stakeholders, led the consultations, design and implementation of the HIRA application initiative, and is responsible for the ongoing maintenance and upgrades to the applications. Ministry of Health, Family and Welfare – provided high-level monitoring of progress. HIRA provided monthly briefings and solicited feedback from Ministry. Private Sector: SK Telecom – provided pro-bono technical knowledge for development of application, the server on which the application is based, training sessions for HIRA staff for maintenance and upgrade of application, and financial investment in the application. Other Korean telecommunication and internet companies: Naver and Daum provided feedback during initial consultations. Naver and Daum are the number 1 and 2 web search engines, respectively, in Korea. They have partnered with HIRA to provide comprehensive hospital information. Consumer Groups: Consumer Research Advocacy Alliance, National Center for Korean Consumers, the YMCA, the YWCA were involved in consultations and participated as members in the Consumer Monitoring group and Patient Advocacy Groups. Healthcare Groups Korean Association of Hospitals, Korean Doctors Association, academic experts participated in patient advocacy groups and consultations. Private Citizens -Senior citizens as target users who provided feedback on the application -University students who provided pro-bono services to assist in the development of the application.
 6. How was the strategy implemented and what resources were mobilized?
The success of the HIRA application initiative was greatly dependent on the formation of a public-private partnership between HIRA, the Ministry of Health and Family Welfare, and SK Telecom as well as the volunteer services of university students, consumer groups, and private citizens to provide knowledge and feedback to the development of the application. The Funding for this initiative is as follows: 2010: $70,000 USD: Initial HIRA application –Cost for initial version of HIRA application –Fully financed by HIRA 2011: $200,000 USD: Version 2 upgrade –Cost for version upgrade to include GPS-technology and other features. –Fully financed by SK Telecom 2013: $200,000 USD: Version 3 upgrade -Cost for additional upgrades and enhancements including security features -Fully financed by HIRA Ongoing maintenance costs without major upgrades are estimated to be $800/month, which is financed through the HIRA budget. Human Resources: The human resources involved in the initial launch of the initiative included the technical expertise and representative voices of 26 members from consumer groups, healthcare groups, and private citizens, 70 HIRA staff members, 5 SK telecom personnel, and 2 university IT students. Currently, there are 2 fully dedicated HIRA staff members who maintain the application and the ongoing efforts of the various committees. Public-Private Partnership (PPP): The partnership with SK telecom was critical from technological, financial, and human resource perspectives. •Technology: GPS-location services is very expensive technology to include in application. SK Telecom provided this service for free to HIRA, which was very important for the functionality of the application and a huge cost saving for the government. They also provided the server on which the application is based for free as well. •Financial: In 2012, SK telecom provided full financial support for the version 2.0 upgrade. •Human Resources: SK telecom staff worked closely with HIRA staff and the university IT students to provide technical expertise for the development of the HIRA application. Their work was critical for ensuring a high-quality product. They also provided training workshops for HIRA staff on how to maintain and upgrade the application thereby increasing in-house technical capacity.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
1.Comprehensive up-to-date information on over 85,000 healthcare facilities. These include over 3000 hospitals, 28,000 clinics, 20,000 pharmacies, 16,000 dental clinics, and 15,000 oriental medicine facilities. Within each it details which departments, services, and medical devices and tests are available. This information is regularly updated by healthcare facilities and subsequently reflected in the HIRA application. The comprehensive and reliable source of information on healthcare facilities assures that citizens can know where to go for a particular health concern wherever and whenever they are located. 2.Location-based service with GPS technology The GPS-enabled location service is available for about 10 features, including GPS-location for hospitals, clinics, pharmacies, and emergency room. It reports the closest health facilities in meters within user radius at any location within the country. Users can also click on a map to view where all the closest facilities are located. This service would also show urban planners where gaps in health care services may exist. 3.Quality ratings and evaluation of hospitals HIRA quality ratings are available for approximately 32,000 hospitals and clinics. Citizens can further access information on how often or experienced a healthcare facility is in providing a certain healthcare service. This gives citizens an objective quality assessment that is more comprehensive and informed than “word-of-mouth” approaches and can also attract patients to lesser-known high-quality health facilities. 4.Estimate of hospital fees and price comparisons The application provides information on estimated hospital fees. This allows citizens to get a sense of the fair range of cost for a given procedure and can allow them to compare prices between healthcare facilities. User surveys have shown this to be one of the most popular features of the application. 5. High quality, user-friendly, and presents data for meaningful use The application is visually appealing, easy-to-use, and presents data in a comprehensible fashion. The application has been continuously tested and enhanced with citizen feedback. The focus on high quality of the HIRA application led to two awards for best smartphone application in 2010.

 8. What were the most successful outputs and why was the initiative effective?
The implementation of the initiative had robust monitoring and evaluation mechanisms through regular reports and meetings by the HIRA application development committee with two principal groups: 1)The HIRA application task force – an interdepartmental committee of senior staff at HIRA that received regular reports from the HIRA application development committee regarding the budget, timeline for completion, and key features of the HIRA applications. 2)Consumer Monitoring Committee – this group is composed of approximately 30 members of civil society groups. They met on a monthly basis during which they received briefings and updates from the HIRA application development committee. The consumer groups provided user satisfaction feedback that they surveyed amongst their constituencies and from their own experience. The recommendations from this group led to over 20 enhancements to the HIRA series of applications. The reports to these two groups included a description of key activities, timeline, and indicators such as: -The development of a strategic plan for comprehensive integration of information -Progress on migration of website information to mobile format -Progress on data migration of each HIRA app feature (e.g. hospital localization, medical diagnostics, specialty services) and how it will be accessed -Demonstration of each HIRA app function and service. -# of healthcare facilities covered, # of services covered, # of informational videos. Feedback from the task force and consumer monitoring committee was used to adjust and enhance the development of the HIRA applications. The HIRA Application task force provided overall oversight and final approval.

 9. What were the main obstacles encountered and how were they overcome?
1.Opposition from major hospitals and healthcare facilities Major hospitals and healthcare facilities expressed concern and initial opposition to certain features of the application, particularly regarding the quality rating. In particular, low-ranking facilities feared that patients would be driven away to other facilities. Large hospitals that had good ratings were also concerned that patients would go to other lesser-known but highly ranked healthcare facilities with this new information. Ongoing discussions and consultations with healthcare facilities helped to allay these concerns. Moreover, the appeal from consumer groups and citizens for access to comprehensive information about healthcare service facilities and their quality ratings was too strong to prevent this information from becoming more accessible. 2.GPS technology and real-time information GPS location services and real-time information were considered to be essential features of the HIRA application. However, the technology for both of these features was costly and sophisticated. The partnership with SK telecom was critical to overcome the technical and financial barriers as they provided the expertise and full financial support for these features. 3.Creating a quality public-sector smart phone application and attracting user interest One of the key challenges was overcoming the negative stereotype of public sector web services and mobile technology. A consumer survey found low user satisfaction amongst government websites and smartphone applications. HIRA was challenged to create an application that was high quality and could attract enough attention to convince users to download it. The intense and ongoing consultations with consumer groups and users, various mechanisms for monitoring and evaluation, and user feedback, as well as the technical expertise provided by HIRA staff, university students, and SK telecom were critical in providing and maintaining a high-quality smartphone application. As the HIRA application started to receive awards and media attention, the user base has continued to expand.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The key benefits of this initiative include: 1.Citizens who can make better health care decisions through information that is easily accessed and understood. The HIRA series of integrated applications is a powerful tool that empowers citizens with information to make better healthcare decisions. Previously much of this information was unavailable, difficult to find, or incomprehensible. The HIRA applications bring a vast amount of data to people without overwhelming them. The HIRA application teams understood the importance of aggregating the information such that data could be used meaningfully to impact the real life situations of citizens. The HIRA applications aim to strike the right balance between comprehensiveness and comprehension. This initiative contributes significantly to a paradigm shift where the knowledge gap between patients and healthcare providers is lessened and citizens are no longer passive participants in their health. From an externally-conducted survey which evaluated the efficiency, quality, and utilization of the HIRA application, 97% of surveyed users found the information regarding hospital services to be “very useful.” Similarly, 95.7% of users found that the ability to check which services were covered by insurance to be “very helpful,” with 66.7% who said that they used this function to look up hospital fees before choosing where to go. Since the launch of the medical fee checking service, the number of people using this service has increased. Since 2012, the HIRA application has received high satisfaction scores and has been increasing ever year. 2.Active citizen engagement and participation. The continuous two-way dialogue between citizens, civil society, private sector, and public servants largely contributed to the success of the initiative. The interaction and cooperation led to the development of a high-quality public service that is responsive to public needs because it directly incorporated the views of citizens. Out of 190 comments from the Health Information Survey, 95 were used to make enhancements to the mobile application. Thus, advances in IT technology have allowed for the lines between the public and public service to become blurred. This creates a more interactive and cooperative model that improves public service. 3.Breaking biases and improving quality of healthcare facilities The HIRA application increases public awareness of quality ratings of healthcare facilities and gives them another evidence-based measure to determine which facility to go to. One of the prevalent notions in Korea is that “bigger is better” in terms of healthcare facilities. Big name hospitals rely heavily on this notion and their prestige to attract patients. While many of these hospitals certainly do offer exceptional services, there is likely to be diversity in quality for different services offered. Moreover, many lesser-known healthcare facilities with excellent quality of care would go by unnoticed. With the HIRA application, citizens can now see a wider choice of quality institutions in their area and may opt for a facility that is more convenient or less expensive but offer as good or better quality than a more famous facility. In addition, as the HIRA application allows citizens at a glance to observe the quality ratings of healthcare facilities this compels facilities to improve their quality ratings through better service. 4. Raise prestige and pride of public sector services and employees The HIRA applications have so far received 3 awards for best mobile application and best public sector application. It has raised the bar in terms of quality for health information applications in Korea – public or private. This service further helps to break the negative stereotype of clunky out-of-date public IT services that provide confusing and dense information. Moreover, public servants involved in this initiative also feel pride in developing a high quality product and service that has received numerous accolades. They also can see how their service has a direct impact on the quality of lives of everyday citizens

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
There are several important mechanisms that ensure the sustainability of the HIRA application: 1.Institutional and financial sustainability The HIRA series of applications is maintained by the Health Information Services department within HIRA with a dedicated team of two personnel. It is fully supported by the annual HIRA budget at approximately $800 per month for maintenance. Increased budget for major improvements and upgrades are requested and granted as needed (e.g. version 3 and 4 upgrades). Within HIRA, the smartphone application has been recognized as a powerful tool that should be maintained and continuously improved to better serve the needs of the public. 2.Improved in-house technical capacity The public-private partnership with SK telecom was a critical element in the success in the development of a high-quality comprehensive informational smart phone application; it also set the foundation for long-term sustainability as SK telecom staff provided training that improved in-house technical capacity of HIRA personnel to maintain and upgrade the systems themselves. 3.Citizen engagement and participation Several avenues of citizen feedback and engagement ensure continued improvements and increasing interest in the application. These include ongoing meetings of the Consumer Monitoring Group, the Patient Advocacy group, consumer satisfaction surveys, and annual public competition to solicit best ideas. The two-way citizen-public sector engagement leads to a virtuous cycle of improvements leading to further use and interest as the HIRA application becomes more responsive to citizen needs. 4.Cost-savings with ICT technology The webzine “Health” has also generated significant cost savings by converting the printed feature solely to an electronic version. This has also increased its readership and visibility. Regarding transferability, the HIRA application model can be replicated in situations where public service agencies and even private enterprises also want to provide important information that can be easily accessed and used meaningfully by the public. Indeed, a private enterprise successfully launched a smartphone application, Medilatte, that was derived from the HIRA application. The Medilatte application connects clients to regionally-based healthcare providers based on HIRA health information data. The HIRA app thus served as a springboard for the creation of this application, which generated approximately $200,000 in from revenue in its first four months of service. Many other government agencies and private enterprises have expressed interest in partnering with HIRA to develop high-quality public service smartphone applications. These include the National Health Insurance Service, the National Center for Consumers, two private application development companies, and foreign research companies. Moreover, HIRA has shared information and experience about HIRA app with over 64 countries where it generated much excitement and discussion particularly regarding citizen empowerment and right to access information about healthcare services. HIRA has expressed its willingness to partner with countries to help develop an application tailored to a country’s local context.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
First and foremost, this initiative demonstrated the importance of freeing “caged information” so that the vast repository of data that is gathered and stored by HIRA can be meaningfully shared with citizens. Not only was this data made public and easily accessible, but it was aggregated and presented in a way that could be easily understood and utilized by citizens.

Contact Information

Institution Name:   Health Insurance Review & Assessment
Institution Type:   Public Agency  
Contact Person:   Jongsu Ryu
Title:   Mr.  
Telephone/ Fax:   82-2-2182-2428/82-2-6710-5849
Institution's / Project's Website:  
Address:   22 Banpo-Daero Seocho-Gu
Postal Code:   137-927
City:   Seoul

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