Designing an effective pay-for-performance system in the Korean National Health Insurance

Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study

Understanding and incorporating patients' perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients' perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients' opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.

Distribution of monetary incentives in health insurance scheme influences acupuncture treatment choices: An experimental study

BACKGROUND

Understanding how doctors respond to occupational and monetary incentives in health care payment systems is important for determining the effectiveness of such systems. This study examined changes in doctors' behaviors in response to monetary incentives within health care payment systems in a ceteris paribus setting.

METHODS

An online experiment was developed to analyze the effect of monetary incentives similar to fee-for-service (FFS) and capitation (CAP) on doctors' prescription patterns. In the first session, no monetary values were presented. In the second session conducted 1 week later, doctors were randomly assigned to one of two monetary incentive groups (FFS group: n = 25, CAP group: n = 25). In all sessions, doctors were presented with 10 cases and asked to determine the type and number of treatments.

RESULTS

In the first session with no monetary incentives, there was no significant difference between the FFS and CAP groups in the number of treatments. When monetary incentives were provided, doctors in the CAP group prescribed fewer treatments than the FFS group. The perceived severity of the cases did not change significantly between sessions and between groups. linear mixed-effects regression model indicated the treatment choices were influenced by monetary incentives, but not by the perceived severity of the patient's symptoms.

CONCLUSION

The monetary values incentivized the doctors' treatment choices, but not their professional evaluation of patients. Monetary values designed within health care systems influence the doctor's decisions in the form of external rewards, in addition to occupational values, and can thus be adjusted by more effective incentives.

Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations

Quality of primary diabetes care is a key health policy concern in many OECD countries with an aging population. This cross-national, population-based study examined the extent and attributes of diabetes-related avoidable hospitalizations (DRAHs) in South Korea and Taiwan, both of which have social health insurance-based health systems with limited gate-keeping for hospitalizations. We analyzed comparable, nationally representative health insurance beneficiary datasets for the two countries (2002-2013), linked with community health resource data. The age- and sex-standardized DRAH rates were calculated, and multivariate, multi-level longitudinal modeling approaches were adopted. The DRAH rate decreased in Taiwan consistently during 2002-2013 and in Korea after 2011 only. Under the universal health coverage, people enjoyed high accessibility to care. A higher number of physician visits reduced DRAHs in Korea but not in Taiwan. Socio-economic disparities in DRAHs still existed in both countries, especially in Taiwan. We found a different trajectory in two similar health systems for the selected health system performance indicator for primary diabetes care. This can be partly explained by different policy approaches to diabetes management in the two countries over the years. Necessary are policy efforts to improve the quality and equality of primary diabetes care and better control of hospital admissions in these two health systems that provide generous access to care at a low cost in East Asia.

Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea

OBJECTIVES

This study analyzed the incidence and characteristics of in-hospital cardiac arrest (IHCA) in Korea based on a sample group of patients that is representative of the population.

METHODS

The incidence of IHCA in adults was extracted from HIRA-NIS-2009, a sample of all patients using medical services in Korea. IHCA patients were analyzed according to gender, age, type of medical institute, and classification under the 6th revision of the Korean Standard Classification of Diseases (KCD-6). In addition, to assess the differences arising from the size of medical institutes, the IHCA incidence was analyzed in relation to the number of inpatient beds.

RESULTS

Based on the sample data, the total incidence of IHCA in Korea was found to be 2.46 per 1,000 admissions (95% confidence interval [CI], 2.37-2.55). A higher incidence was found among men at 3.18 (95% CI, 3.03-3.33), compared to women at 1.84 (95% CI, 1.74-1.94). The incidence of IHCA was also higher in hospitals that had more than 600 inpatients beds at 5.40 (95% CI, 5.16-5.66) in comparison to those that had less than 600 inpatients beds at 4.09 (95% CI, 3.76-4.36) (p < 0.001). By primary disease, the incidence was the highest for infectious diseases.

CONCLUSIONS

We demonstrated that the IHCA incidence based on gender, age, diagnostic group, and number of beds could be analyzed using the insurance claim data from a national representative sample.

Impact of health insurance status changes on healthcare utilisation patterns: a longitudinal cohort study in South Korea

OBJECTIVES

The study examined medical care utilisation by health insurance status changes.

SETTING

The Korean Welfare Panel Study (KoWePs) was used.

PARTICIPANTS

This study analysed 14,267 participants at baseline (2006).

INTERVENTIONS

The individuals were categorised into four health insurance status groups: continuous health insurance, change from health insurance to Medical Aid, change from Medical Aid to health insurance, or continuous Medical Aid.

PRIMARY AND SECONDARY OUTCOME MEASURES

Three dependent variables were also analysed: days spent in hospital; number of outpatient visits; and hospitalisations per year. Longitudinal data analysis was used to determine whether changes in health insurance status were associated with healthcare utilisation.

RESULTS

The number of outpatient visits per year was 0.1.363 times higher (p<0.0001) in the continuous Medical Aid than in the continuous health insurance group. The number of hospitalisations per year was 1.560 times higher (p<0.001) in new Medical Aid and -0.636 times lower (p<0.001) in new health insurance than in continuous health insurance group. The number of days spent in hospital per year was -0.567 times lower (p=0.021) in the new health insurance than in the continuous health insurance group.

CONCLUSIONS

Health insurance beneficiaries with a coverage level lower than Medical Aid showed lower healthcare utilisation, as measured by the number of hospitalisations and days spent in hospital per year.