Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Policy Elites' Perception of Health Policy Governance: Findings from In-depth Interviews of Korean New Diagnosis Related Group Payment

정책 전문가의 인식을 통해 본 한국 보건의료정책 거버넌스: 신포괄수가제 사례에 관한 심층면접 결과

  • Shon, Changwoo (Graduate School of Public Health, Seoul National University) ;
  • Kwon, Soonman (Graduate School of Public Health, Seoul National University) ;
  • You, Myoungsoon (Graduate School of Public Health, Seoul National University)
  • Received : 2013.10.11
  • Accepted : 2013.12.25
  • Published : 2013.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of 'governing health policy'-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.

Keywords

References

  1. Scott WR. Institutions and organizations. 2nd ed. Thousand Oaks: Sage; 2001.
  2. Shepsle KA. Studying institutions: some lessons from the rational choice approach. J Theor Politi 1989;1(2):131-147. https://doi.org/10.1177/0951692889001002002
  3. Freidson E. Professionalism: the third logic. London: Polity; 2001.
  4. Baek HJ. New medical professionalism. J Rheum Dis 2012;19(6):316-325. https://doi.org/10.4078/jrd.2012.19.6.316
  5. Park HJ. The concept of medical professionalism as for self-employed physicians in Korea. J Korean Med Assoc 2011;54(11):1154-1163. https://doi.org/10.5124/jkma.2011.54.11.1154
  6. Kang HG. Changes in central-local relations and self responsibility in local finance in Japan: with a particular reference to bankruptcy of Yubari and policy lessons for local government in Korea. Korean Assoc Gov Stud 2008;20(2):23-47.
  7. Lee KH, Kwon SM. Separation of drug prescribing and dispensing. Korean Assoc Policy Stud 2004;13(5):255-278.
  8. Korean Medical Association. Resolution rally for anti-DRG introduction. Announced news. 2012 Jun 8.
  9. Korean Intern Resident Association. Best practicing is die. Announced news. 2013 Jul 1.
  10. Kim CY. Theory of health security. Seoul: Han-ul Academy Press; 2009.
  11. Busse R, Geissler A, Quentin W, Wiley M. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Maidenhead: Open University Press; 2011.
  12. Boyce C, Neale P. Conducting in-depth interviews: a guide for designing and conducting in-depth interviews for evaluation input. Watertown (MA): Pathfinder International; 2006.
  13. Kim SJ, Kang IH, Kim JY, Kang JS, Moon BG, Lee JY, et al. Understanding governance. Seoul: Dae young Co. Press; 2002.
  14. Kim EY. Governance and NGO in national health insurance sector. Korean J Citiz Polit 2003;6:67-96.
  15. Kim JY. The future of government for the governance: new public management and policy network. Korean Assoc Admin Stud 2000;34(1):21-39.
  16. Choi SW. The research trend of governance in Korea: a critical review from new governance perspective. Korean Assoc Gov Stud 2003;10:111-125.
  17. Joseph RA. State, conflict, and democracy in Africa. Boulder (CO): Lynne Reinner; 1999.
  18. Kjaer AM. Governance. Malden (MA): Polity Press; 2004.
  19. Andrews M. Good government means different things in different countries. Governance 2010;23(1):7-35. https://doi.org/10.1111/j.1468-0491.2009.01465.x
  20. Olafsdottir AE, Reidpath DD, Pokhrel S, Allotey P. Health systems performance in sub-Saharan Africa: governance, outcome and equity. BMC Public Health 2011;11:237. https://doi.org/10.1186/1471-2458-11-237
  21. Davis KE, Kingsbury B, Merry SE. Indicators as a technology of global governance. Law Soc Rev 2012;46(1):71-104. https://doi.org/10.1111/j.1540-5893.2012.00473.x
  22. Savedoff WD, Gottret PE. Governing mandatory health insurance: learning from experience. Washington (DC): The World Bank; 2008.
  23. Rhodes R. The new governance: governing without government. Politi Stud 1996;44(4):652-667. https://doi.org/10.1111/j.1467-9248.1996.tb01747.x
  24. Pierre J, Peters BG. Governance, politics and the state. Basingstoke: Palgrave Macmillan; 2000.
  25. Hirst P. Democracy and governance. In: Pierre J, editor. Debating governance: authority, steering, and democracy. Oxford: Oxford University Press; 2000.
  26. Goss S. Making local governance work: networks, relationships, and the management of change. New York: Palgrave; 2001.
  27. Miller WL, Dickson M, Stoker G. Models of local governance: public opinion and political theory in Britain. New York: Palgrave; 2000.
  28. Lovan WR, Murray M, Shaffer R. Participatory governance in changing world. In: Lovan WR, Murray M, Shaffer R, editors. Participatory governance: planning, conflict mediation and public decision-making in civil society. Aldershot: Ashgate Publising; 2004. pp. 1-21.
  29. Tang S, Mazmanian D. An agenda for the study of collaborative governance. [Unpublished Working Paper]; 2008.
  30. Jung YD. Seeking for Korean governance paradigm: governance and state capacity. The Korean Association for Public Administration Conference; 2005; Dec 9-10; Seoul, Korea.
  31. Kim KW. Partnership and effective state administration. Seoul: Beobmoosa Press; 2000.
  32. Moon TH. An analysis of the determining factors in the successful cultural policy governance for the regional innovation: the case of the executive committee. Korean Association of Governmental Studies 2005;17(2): 337-358.
  33. Bae EH. Local governance: from conflict to collaboration. Local Admin Stud 2005;19(2):188-215.
  34. Kim I. Impacts of governance structure on performance in public service delivery: a comparative study by service type. Korean Assoc Admin Stud 2006;40(4):51-75.
  35. Kim DH, Jung JG. Achievements and limits of local governance in Ulsan metropolitan city: a case study on participatory budgeting and civil jury system. Korean Assoc Policy Stud 2006;15(3):131-159.
  36. You JW, Lee SM. Hierarchy, market, network: an empirical analysis of governance of ward office in Seoul. Korean Assoc Admin Stud 2008; (42)3:191-213.
  37. Choi SH, Roh JH, Sung JS. The study of the success factors of cooperative local governance: case of Dohwa knoll in Jinan-gun. J Local Gov Stud 2009;23(1):499-522.
  38. Jung SH, Jung CH. The impact of crisis of governance on increasing debt of local government. Korea Public Admin J 2011;20(3):125-161.
  39. Yang GY. Changing on social service delivery system and public character: focus on community service and the governance. Korean Public Manag Rev 2013;27(3):89-114. https://doi.org/10.24210/kapm.2013.27.1.004
  40. Bok MS. Partnership in governance era and reflection upon the regional NGOs. Korean Gov Rev 2005;12(1):25-51.
  41. Ra MG. Governance, NGO, and community: focusing on NGO in Cheong-ju area. Korean Gov Rev 2006;13(3):227-254.
  42. Jeon YS, Back HB. A research on role possibilities of public officials' labor unions in governance system: focused on structural analyses of the public servants' cognition about governance in the central and local government. Korean J Local Gov Stud 2012;26(2):183-216.
  43. Jeon YS. Analyze of the cognitions and the attitudes of local public servants in Chungju city and Hongcheon county about local governance. J Local Gov Stud 2013;25(1):117-143.
  44. Lee SJ, Kim HK, Choi JK. Social capital and formation of policy governance. Korean Assoc Admin Stud 2008;4(1):149-170.
  45. Jung MA. The role of civil society and new governance between Korea and Japan. J Asia-Pacific Stud 2011;18(2):17-41. https://doi.org/10.18107/japs.2011.18.2.002
  46. Choi DO, Ju HH. A consideration on Yellow Sea governance of Korea and China. J Korean Soc Mar Environ Saf 2013;19(1):186-192. https://doi.org/10.7837/kosomes.2013.19.2.186
  47. Shin HJ. Local governance of medical and health sector in developing country: focus on the Philippines and Zambia. Korea Assoc Policy Stud 2002;6(3):93-112.
  48. Hwang SK. A study on the modeling of local healthcare governance. Korean J Local Gov Stud 2012;16(4):137-161.
  49. Jin YC, Moon SH. A study of health care governance in Korea: focus on national health insurance. The Korean Association for Governance Conference; 2006; June 16-17; Gwangju, Korea.
  50. Jung YH. On the governance of health care. Health Welf Policy Forum 2007;131:110-119.
  51. Jung YH. A study on the governance of non-profit health care organizations in selected countries. Health Welf Policy Forum 2009;149:116-129.
  52. Lee HC. Governance and NGOs: a case study of the new drug prescription system, the separation of pharmacy and dispensary. Koran Polit Sci Stud Rev 2001;35(3):217-236.
  53. Kwak JY. Searching for good governance of Korean medical policy: case study of the separation of dispensary from medical practice. Korean Party Stud Rev 2010;9(1):149-180.
  54. Kim SJ, Kwon SM, You MS. An institutional and ecological analysis of the healthcare environment in Korea: focus on institutional logic, actors, governance. J Public Health 2011;21(3):457-492. https://doi.org/10.4332/KJHPA.2011.21.3.457
  55. Yu TK. Healthcare system's governance construction type in medical tourism advanced. Korean Public Manag Rev 2009;23(4):257-280. https://doi.org/10.24210/kapm.2009.23.4.011
  56. Department of Health. A first class service: quality in the new NHS. London: Department of Health; 1998.
  57. Wilson J. Clinical governance. Br J Nurs 1998;7(16):987-988. https://doi.org/10.12968/bjon.1998.7.16.5615
  58. Butterworth T, Woods D. Clinical governance and clinical supervision: working together to ensure safe and accountable practice. Manchester: School of Nursing, Midwifery and Health Visiting, University of Manchester; 1999.
  59. Crinson I. Clinical governance: the new NHS, new responsibilities? Br J Nurs 1999;8(7):449-453. https://doi.org/10.12968/bjon.1999.8.7.6650
  60. Goodman NW. Clinical governance. BMJ 1998;317(7174):1725-1727. https://doi.org/10.1136/bmj.317.7174.1725
  61. Scally G, Donaldson LJ. The NHS's 50 anniversary. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998;317(7150):61-65. https://doi.org/10.1136/bmj.317.7150.61
  62. The King's Fund. What is clinical governance? London: Briefings; 1999.
  63. Paris JA, McKeown KM. Clinical governance for public health professionals. J Public Health Med 1999;21:430-434. https://doi.org/10.1093/pubmed/21.4.430
  64. Finkelstein L. What is global governance? Glob Gov 1995;1(3):367-372. https://doi.org/10.1163/19426720-001-03-90000007
  65. Frechette L. What do we mean by global governance? London: Overseas Development Institute; 1998.
  66. Kudrle, R. Three types of globalization: communications, market, and direct. In: Vayrynen R, editor. Globalization and global governance. Lanham: Rowman & Littlefield; 1999. pp. 127-149.
  67. Hewson M, Sinclair TJ. Approaches to global governance theory. Albany (NY): State University of New York Press; 1999.
  68. Buse K, Walt G. Global public-private health partnerships: part II, what are the health issues for global governance? Bull World Health Organ 2000;78(5):699-709.
  69. Fidler DP. Architecture amidst Anarchy: global health's quest for governance. Glob Health Gov 2007;1(1):1-17.
  70. Savedoff WD. Governance in the health sector: a strategy for measuring determinants and performance. Portland: Social Insight; 2009.
  71. Ng NY, Ruger JP. Global health governance at a crossroads. Glob Health Gov 2011;3(2):1-37.
  72. Institute for Health Metrics and Evaluation. Financing global health 2010: development assistance and country spending in economic uncertainty. Seattle: Institute for Health Metrics and Evaluation, University of Washington; 2010.
  73. Feachem R, Yamey G, Schrade C. A moment of truth for global health. BMJ 2010;340:c2869. https://doi.org/10.1136/bmj.c2869
  74. Mikkelsen-Lopez I, Wyss K, de Savigny D. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights 2011;11:13. https://doi.org/10.1186/1472-698X-11-13
  75. Brinkerhoff DW, Fort C, Stratton S. Good governance and health: assessing progress in Rwanda. TWUBAKANE Decentralization and Health Program Rwanda Report. Chapel Hill: IntraHealth International; 2009.
  76. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy 2009;90:13-25. https://doi.org/10.1016/j.healthpol.2008.08.005
  77. World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: World Health Organization; 2007.
  78. World Health Organization. Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe. Geneva: World Health Organization; 2011.

Cited by

  1. Analysis of Changes in Patient Costs in 7Diagnosis-Related Groups through Time Series Analysis vol.11, pp.3, 2017, https://doi.org/10.12811/kshsm.2017.11.3.023