Résumé
The effort to measure and improve the quality of healthcare is a common health policy issue worldwide. Korean Value Incentive Programme is one of that effort, but some concerns exist. Compared to pay for performance program in other countries, it measures healthcare quality with relatively narrow performance domain using a small number of clinical indicators. It was designed without involving hospitals and other key stakeholder, and program participation was mandated. Highest and lowest performers get bonus and penalty using relative ranking. As a suggestion for development, the direction for quality management at the national level should be given first. Therefore the philosophy or strategy for quality improvement should be reflected to the program. And various domains and indicators of healthcare quality should be developed with active communication with healthcare providers. The evaluation method is necessary to be changed to provide achievable goal to the healthcare providers and attract quality improvement.
Sujets)
Humains , Personnel de santé , Politique de santé , Méthodes , Motivation , Philosophie , Amélioration de la qualité , Qualité des soins de santé , Remboursement incitatifRésumé
In 2014, there were disagreements between the Value Incentive Program (VIP) of the Health Insurance Review and Assessment Service (HIRA) and academic societies. The primary differences of opinion arose over acute myocardial infarction and stroke, which are the first disease targets of the VIP. The quality of healthcare is one of the three components of the iron triangle in healthcare policy. Improving the quality of care requires effort from both internal approach(medical community) and external approach. The scope of HIRA for improving and monitoring the quality of care could be widened because (as of 2012) HIRA deals with only 16 items of quality improvement and assessment; does not monitor the total scope of medical services, patient safety, and patient experiences; and the VIP of HIRA is contains solely a quality dimension without a cost dimension. Therefore, HIRA should cooperate with medical communities to effectively improve the quality of care and expand procedures for quality improvement, assessment, and monitoring. HIRA must keep in mind that, with regard to improvement of quality of care, its role is not regulatory in nature, but cooperative.
Sujets)
Humains , Prestations des soins de santé , Assurance maladie , Fer , Motivation , Infarctus du myocarde , Sécurité des patients , Amélioration de la qualité , Qualité des soins de santé , Accident vasculaire cérébralRésumé
In 2014, there were disagreements between the Value Incentive Program (VIP) of the Health Insurance Review and Assessment Service (HIRA) and academic societies. The primary differences of opinion arose over acute myocardial infarction and stroke, which are the first disease targets of the VIP. The quality of healthcare is one of the three components of the iron triangle in healthcare policy. Improving the quality of care requires effort from both internal approach(medical community) and external approach. The scope of HIRA for improving and monitoring the quality of care could be widened because (as of 2012) HIRA deals with only 16 items of quality improvement and assessment; does not monitor the total scope of medical services, patient safety, and patient experiences; and the VIP of HIRA is contains solely a quality dimension without a cost dimension. Therefore, HIRA should cooperate with medical communities to effectively improve the quality of care and expand procedures for quality improvement, assessment, and monitoring. HIRA must keep in mind that, with regard to improvement of quality of care, its role is not regulatory in nature, but cooperative.
Sujets)
Humains , Prestations des soins de santé , Assurance maladie , Fer , Motivation , Infarctus du myocarde , Sécurité des patients , Amélioration de la qualité , Qualité des soins de santé , Accident vasculaire cérébralRésumé
The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.