Korean national health insurance system is the only, out-of-optional system controlled by government. Although additional private medical insurance is applied by company, 98% of citizens were signed up this obligatory system. If a patient got medical service, only 30% deductible in primary clinic and 60% of university hospital. In hemodialysis, patients only pay 10% of total medical fee. Health Insurance Review& Assessment service, HIRA controls the medical payment system. It decides which service would be accepted insurance criteria and pays to the hospitals. Hemodialysis quality control system is developed in 2008 for avoid any over-due/mis-due/under-due medical service and for reduce the difference among the hospitals. Their final objective is patients’ satisfaction. Also, people could get information of the hospital and and right of choice, hospitals could get incentives and supported quality control, and government could improved politics and value of the money. However, government wants save the tax, clinicians think higher quality needs higher cost, and the patients wants higher quality of care with chief price. The criteria of HD quality assess consists with system, process, and outcome. System includes human resource (doctors and nurses) which implies how many patients they care (lower number represents higher quality of care), water examination (regular culture and infection, heavy metal control), and isolation of HBV machine and preparing emergency kit in HD unit. Process represents HD adequacy (KT/V) and AVF stenosis monitoring, and regular laboratory test. Outcome includes how many patients met KT/V over 1.2 and calcium phosphorus complex less than 55. Among 839 candidate units, 42 were tertiary hospital, 225 were general hospital (>100 beds), 90 were hospital (<100 beds), 96 were nursing hospital, and 386 were primary care clinic. Average points of tertiary hospital was 96.5, general hospital 87.2, hospital 76.7, nursing hospital 79.1, and primary clinic was 83.4. University hospital showed highest quality as expected. Interestingly, hospitals shows less HD quality than primary care clinic because they were doing more numbers of dialysis with similar numbers of doctor and nurses. Although HIRA supplies incentives, but more than half of the budget was headed to tertiary hospitals which has higher human resources. HD quality control is essential to the patients’ QOL and survival, but should be considered patients’ co-morbidity and ethical issues of dialysis units.