Nationwide Quality Assessment of Lung Cancer Management in Korea: Based on Second-Cycle Health Insurance Review and...

Lung cancer remains the leading cause of cancer-related mortality worldwide. To improve lung cancer care quality, the Health Insurance Review and Assessment Service (HIRA) in Korea conducted the first phase of second-cycle adequacy assessment, incorporating patient-centered and outcome-based indicators.

This study analyzed HIRA claims data from 106 medical institutions treating lung cancer for the period July 2022 to June 2023. The assessment evaluated treatment adequacy based on structural, procedural, and outcome indicators across tertiary care hospitals, general hospitals, and clinics.

The second-cycle evaluation adopted a comprehensive framework, incorporating multidisciplinary care and end-of-life management. Among 21,517 cases, 44 tertiary care hospitals managed 75.9%, while 62 general hospitals handled 24.1%. The average adequacy score was 91.09, with 80.7% of institutions rated grade 1. The multidisciplinary consultation rate was 30.8%, exceeding the 12.6% target. Surgery within 30 days of diagnosis was performed in 93.2% of cases, while the overall surgical mortality rate was 1.19%, lower in tertiary care hospitals (1.04%) than in general hospitals (1.88%). The 30 days readmission rate was 2.26%, while 56.8% of patients received hospice counseling.

The second-cycle assessment emphasized patient-centered and outcome-based care, integrating multidisciplinary consultation and hospice indicators. These findings suggest that lung cancer treatment institutions in South Korea maintain high adequacy standards. Continuous improvements will be necessary to exploit medical advances and improve lung cancer management.