RESUMO
BACKGROUND: The COVID-19 pandemic has caused delays and restrictions in providing medical services. In response to the medical surge, countries with social insurance systems provided financial incentives to medical institutions. This study aimed to present the directions for health insurance support by comparing countries in terms of the domains and contents of COVID-19 health insurance support to ensure timely support in case of future pandemics. METHODS: An analysis framework was developed to compare health insurance policy interventions for COVID-19 and non-COVID-19 domains, and detailed policy interventions were divided into sub-domains (space, staff, and stuff) for each domain. Data were collected by country from the websites of the Ministry of Health and Social Insurers, Organisation for Economic Co-operation and Development, and European Observatory on Health Systems and Policies and were analyzed using qualitative comparative analysis. RESULTS: The countries provided comprehensive support for both the COVID-19 and non-COVID-19 domains. In the COVID-19 domain, overall support was provided in all three sub-domains. Additional cost support was provided to prevent infection and provide secure facilities to treat confirmed patients. Outpatient services were mainly supported, and an intensive intervention was developed in the staff sub-domain for the non-COVID-19 domain. The point of policy intervention was the surge of the first confirmed case. Continuous revisions were subsequently made. The government provided financial support through health insurance. CONCLUSIONS: Regarding where policy support through health insurance should be focused, the workload of medical personnel increased according to the change in the service provision environment due to the pandemic, and the medical service delivery system changed to prevent further infection. Consequently, incentives should be provided to aid the provision of stable services to patients and should be an auxiliary means to implement the national quarantine policy more effectively via a health insurance response system that promptly provides additional financial support in case of future crises.
RESUMO
Background: South Korea has utilized its National Health Insurance (NHI) system to adjust the medical fees payable for healthcare services, to financially support the frontline healthcare providers combating COVID-19. This study evaluated the composition of such adjustments to the medical fees-made to secure resource surge capacity against the pandemic-in South Korea. Methods: Descriptive statistics and schematization were employed to analyze 3,612,640 COVID-19-related NHI claims from January 1, 2020, to June 30, 2021. COVID-19 suspected and confirmed cases were evaluated based on the proportion of fees adjustment, classified into space, staff, or stuff (3S) using diagnosis codes. The proportion of fees adjustment was investigated in terms of the healthcare expenditure, number of patients, and number of healthcare services covered. Findings: First, in terms of cost, medical fee adjustments covered over 96% of the total costs arising from the increased demand for testing (stuff) and isolated spaces among patients suspected of having COVID-19. Second, medical fees were adjusted to cover over 80% of the cost attributable to COVID-19 confirmed cases, in relation to isolated spaces and medical staff support. Third, the adjustment of less than 10% of the various types of medical fees, if selected strategically, can effectively induce a surge in resource capacity. Interpretation: South Korea has improved its existing surge capacity by adjusting the medical fees payable through NHI to healthcare providers. Particularly, through the provider payment system of fee-for-service, the Korean government could prevent the spread of infection and protect the medical staff assigned to respond to COVID-19. However, additional studies on alternative payment systems are needed to control costs while maintaining an effective pandemic response system in the face of the prolonged COVID-19 outbreak.
