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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 23, Issue 4 - Dec 2013
Volume 23, Issue 3 - Sep 2013
Volume 23, Issue 2 - Jun 2013
Volume 23, Issue 1 - Mar 2013
Selecting the target year
The Possibility of Expanding Pay-for-Performance Program as a Provider Payment System
Tchoe, Byongho ; Lee, Suehyung ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 3~18
DOI : 10.4332/KJHPA.2013.23.1.003
This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.
The Impact of Outpatient Coinsurance Rate Increase on Outpatient Healthcare Service Utilization in Tertiary and General Hospital
Kim, Hyo-Jeong ; Kim, Young-Hoon ; Kim, Han-Sung ; Woo, Jung-Sik ; Oh, Su-Jin ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 19~34
DOI : 10.4332/KJHPA.2013.23.1.019
Background: The study describes the changes resulted from imposition on tertiary hospital outpatient coinsurance rate rise policy and in tertiary or general hospital drug coverage rise policy on healthcare service utilization. Methods: Accordingly, the hypothesis about outpatient healthcare utilization after rise policy in outpatient coinsurance rate and drug coverage was established, using interrupted time-series analysis and segmented regression analysis to test the hypothesis. 5-year analysis period (2007. 3-2012. 3) from the outset year was designated, the data about most common 10 high-ranking of the main diseases targeting visiting patient from age of 6 to 64 were collected. Results: The summary on the major research is followed. First, the medical expense and duration of treatment tends to be increased in case of imposition about rise policy in outpatient coinsurance rate in the tertiary hospital under the interrupted time-series analysis. It showed temporary increase and slow down on account of influenza A even after the policy enforcement. In segmented regression analysis, duration of visit and medical expense in the tertiary hospital increased temporally right after the policy implementation and the decreased rapidly depends on period. Both rise and fall is statistically significant. The second, In case of tertiary or general hospital outpatient drug coverage rise policy, all of the tertiary hospital healthcare service utilization variables by the interrupted time-series analysis, drug coverage policy in the general hospital deeply declined according to decreasing trend before policy implementation. The third, in case of segmented regression analysis, the visit duration and medical expense statistically declined right after the policy implementation in both the tertiary and general hospital. Meanwhile, administration day was statistically meaningful only for the decrease right after the policy implementation. Otherwise, general hospital changes are not statistically meaningful. And the medicine cost was statistically, meaningfully decreased after the increase in drug coverage. Conclusion: Finally, the result demonstrated according to the analysis is only 1 hypothesis is denied, the other 2 are partially supported. Then, tertiary hospital outpatient coinsurance rate increase policy comparatively makes decrease effect on long-term healthcare utilization, and tertiary or general hospital outpatient drug coverage policy showed partially short-term effect is assured.
Differences of Medical Costs by Classifications of Severity in Patients of Liver Diseases
Shin, Dong Gyo ; Lee, Chun Kyoon ; Lee, Sang Gyu ; Kang, Jung Gu ; Sun, Young Kyu ; Park, Eun-Cheol ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 35~43
DOI : 10.4332/KJHPA.2013.23.1.035
Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.
Evaluation of the Homogeneity of Korean Diagnosis Related Groups
Kim, Hyung Seon ; Lee, Sun Hee ; Nam, Chung Mo ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 44~51
DOI : 10.4332/KJHPA.2013.23.1.044
Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV > 100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV > 100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.
Responsiveness of Public Health Center and Its Related Factors against H1N1 Epidemic
Jang, Jung Lang ; Kim, Keon Yeop ; Hong, Nam Soo ; Kam, Sin ; Lee, Won Kee ; Lee, Yu Mi ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 52~58
DOI : 10.4332/KJHPA.2013.23.1.052
This study was conducted to investigate the responsiveness and its related factors of public health center for novel influenza A (H1N1) epidemic. The data was collected through a web-based survey conducted during February to April 2011. The 182 respondents were team leaders or persons who were responsible for H1N1-related work at public health centers during the H1N1 prevalence. The related factors affecting the responsiveness were different by urban or rural area. In the level of gu (urban) area, cooperation with the public organizations, preparing its own response plan were the significant factors. But, in the level of si or gun (rural) area, cooperation with private organizations (clinic or pharmacy), physical (facilities, equipments, and medicines), and human infrastructures (public health professions, education and knowledge, and motivation) were more important factors. Therefore, how to cope with H1N1 prevalence in the future should be different by local characteristics. As a result, there are several challenges that public health centers should prepare for the further emerging infectious diseases. First, it is needed to make standard manuals which could strengthen education and training in order to respond appropriately, as well as to prepare enough physical infrastructures for the crisis. Next, the public health center should prepare correct media response and cooperation system with public and private organizations.
Factors of Health Care Expenditure of Local Government
Park, Sam Young ; Jang, Min Young ; Park, Sun Hee ; Na, Baeg Ju ; Kim, Eun Young ; Kim, Soon Young ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 59~65
DOI : 10.4332/KJHPA.2013.23.1.059
Background: The purpose of this study was to analyze the related factors which decide the percentage of health care expenditure of the total fiscal expenditure of local governments and to provide the basic data to contribute for the efficient allotment of healthcare budget. Methods: This study was conducted by the percentage of health care expenditure for 3 years by classifying a total of 230 local governments into the metropolitan cities (gu, 69), the counties (si, 75), and the boroughs (gun, 86) all over the country. With the collected data, the general characteristics of independent variables and the dependent variable were analysed using SPSS ver. 18.0, The correlation analysis and multivariate regression analysis were conducted for the characteristics of variables according to regions by year. Results: In correlation between health care expenditure by year and other variables, there was a significant positive correlation with unemployment rate, metropolitan cities (gu) and other regions, the percentage of health center personnel, health care expenditure in last year as a independent factors. On the other hand there was no correlation with social assistance recipients and the percentage of aging population, financial self-reliance, industrialization rate, suicide rate, cardiac disease mortality, cerebrovascular mortality on health care expenditure. Conclusion: The study clearly shows that health care expenditure of local governance was not correlated with health care need factors comparing social welfare expenditure.
The Influence Factors and Effects of Self-leadership: Focusing on Members of the Hospitals
Min, Byung Chul ; Lim, Sung Won ; Kim, Han Kyoul ; Rhee, Hyun Sill ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 66~77
DOI : 10.4332/KJHPA.2013.23.1.066
The purpose of this empirical study is to investigate the factors of self-leadership depending on individual characteristics, job characteristics, and qualities of leader-member exchange. Additionally, this study aims to discover the effect of self-leadership's outcome factors on organizational citizenship behavior and innovative activities. In order to verify research model and hypothesis, questionnaires were collected from department members working at general hospitals, hospitals, and clinics in metropolitan area of Seoul, which were 85 departments and 344 respondents. Collected data were analyzed with SPSS ver. 19.0 and Amos ver. 18.0 statistical package using Structural Equation Model. The results of the analysis showed that both individual characteristics and job characteristics have significant positive effect on self-leadership. Also, self-leadership had significant positive relationship on innovative action and organizational citizenship behavior. The implications of this study are as follow. First, this study empirically explained how self-leadership is applied in healthcare organizations. Second, it verified the relationship between causal factors and outcome factors of self-leadership. Also, prior researches of self-leadership have been conducted on business companies, but this study explored self-leadership at healthcare organizations, which increased external validity. Nowadays, many people are interested in the effect of leadership in order to overcome issues coming from enlarged organizations and to improve performance. Self-leadership will contribute to maximizing voluntary efforts of human resources and performance in a rapidly changing healthcare industry.
Analysis on Efficiency and Productivity Changes of Regional Public Hospitals in Korea with Data Envelopment Analysis/Window and Global Malmquist Indices Models
Yang, Dong Hyun ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 78~89
DOI : 10.4332/KJHPA.2013.23.1.078
This study empirically analyze efficiency and productivity changes of public hospitals of Korea using data envelopment analysis/Window model and global Malmquist indices model. We use the ten-year data from 2001 to 2010 of 30 regional public hospitals listed database from the Association of Korean Regional Public Hospitals. The main focuses are to reveal whether the technical inefficiency are improved as time goes by, and efficiency and productivity are affected by environmental factors. The results can be summarized as follows. First, the efficiencies of public hospitals rise in trend as time passes. Second, regional public hospitals show the different average efficiencies according to their regional type, hospital type, operational type, medicaid type, and demand and supply conditions by Mann-Whitney U-tests. Third, technical efficiency changes mainly contribute to 4.4% annual average growth rate of productivity of regional public hospitals during that period. Our findings have some policy implications. It is confirmed that there exist some environmental inefficiencies, and those inefficiencies can not be overcome through just improving the inner management system. Thus, policy and institutional changes are necessary for regional public hospitals to improve efficiency and productivity overall.
The Long-term Care Utilization of the Elderly with Dementia, Stroke, and Multimorbidity in Korea
Jeon, Boyoung ; Kwon, Soonman ; Kim, Hongsoo ;
Health Policy and Management, volume 23, issue 1, 2013, Pages 90~100
DOI : 10.4332/KJHPA.2013.23.1.090
Background: This study examined the relationships of dementia, stroke, and combined multimorbidity with long-term care utilizations among older people in South Korea. Methods: A nationally representative sample of 10,130 older adults who used long-term care services in 2010 were analyzed. We used the 5% sample of aged 65 years or older linked with National Health Insurance Corporation registry data of long-term care insurance system. The sample was categorized into three groups: dementia only (47.6%), stroke only (36.3%), and both dementia and stroke (16.1%). We estimated the use of institutional care, home care, and total expenditure of long-term care services, adjusting for the severity of each function (such as daily life, behavior or cognitive change, nursing care needs, and rehabilitation care needs) and sociodemographic characteristics. Results: Having dementia symptoms was positively associated with the use of institutional care services, on the other hand, having stroke symptoms was positively related with the use of home care. The total long-term care cost was higher in the group of having both dementia and stroke. Conclusion: Older persons with dementia symptoms and stroke symptoms have different patterns of long-term care utilization, and the multimorbidity increased the overall expenditure of long-term care utilization. These findings imply a need for differentiated management strategy targeting physically and cognitively impaired older persons, and special concerning for persons with multimorbidity conditions for long-term care insurance program in Korea.