Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Enhancement of Korea medical delivery system : Two policy proposals and healthcare policy making governance

의료전달체계 정립을 위한 두 가지 정책 제안과 보건의료정책 거버넌스에 관한 연구

  • O, Dongil (Department of Finance and Management, SangMyung University)
  • 오동일 (상명대학교 금융경영학과)
  • Received : 2016.01.21
  • Accepted : 2016.04.07
  • Published : 2016.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

The Medical Service Act of Korea describes a clinic as providing services primarily to outpatients, while a large general hospital provides specialized medical services requiring a high level of expertise for treating serious diseases. The portion of medical revenue for clinics has been decreasing gradually compared with large hospitals. This article proposes two fundamental medical policies to fix the distorted medical delivery system of Korea. Firstly, uniform additional medical remuneration rates based on the type of medial institution should be divided into outpatient additional rates and inpatient additional rates. Secondly, to normalize the function of clinics and large general hospitals, an outpatient medical target budget system should be introduced. Finally, to properly implement the proposal, it is important to establish healthcare policy-making governance. The success of policy implementation strongly depends on the participation and incentives of the government, suppliers, and patients. Healthcare policy-making governance must be designed to encompass this fact and improve quality of care.

의료법에서는 의원은 외래환자를, 상급종합병원은 중증의 입원환자를 전문적으로 치료하는 의료기관으로 규정하고 있다. 그러나 일차의료를 제공하는 의원의 외래환자수는 위축되는 반면 상급종합병원의 외래진료비 비중은 지속적으로 증가하고 있다. 이 연구에서는 우리나라 의료전달체계를 정상화하기 위한 보다 근원적인 방안으로 두 가지 정책안을 제시하고 이 정책을 정착시키고 성공시키기 위한 보건의료정책 거버넌스에 관한 제안을 담고 있다. 상급종합병원의 중증 환자 진료기능을 강화하기 위하여 현행 종별가산율을 외래와 입원 종별가산율로 분리하고 외래진료비 목표관리제 도입이라는 두 가지 방안을 제시하였다. 그리고 이들 정책안을 큰 부작용없이 성공시키기 위한 보건의료 정책 거버넌스를 제안하였다. 보건의료 정책 거버넌스는 의료공급자, 환자의 참여와 동기부여가 전제되어야 하며 장기적인 관점에서는 향후 의료 질을 반영할 수 있도록 설계되어야 한다.

Keywords

References

  1. Ministry of Health and Welfare, Medical Service Act, Act No. 10387, Jul. 23, 2010.
  2. Hutchison, B., "A Long Time Coming: Primary Healthcare Renewal in Canada", Healthcare Papers 8(2), pp.10-224, 2008. DOI: http://dx.doi.org/10.12927/hcpap.2008.19704
  3. Doctorstimes, MERS, the opportunity to reform medical delivery system, 2015.7.20.
  4. Starfield B, Shi L, Macinko J., "Contribution of primary care to health systems and health", Milbank Quarterly" 83(3), pp.457-502, 2005. PMID: 16202000. DOI: http://dx.doi.org/10.1111/j.1468-0009.2005.00409.x
  5. Pieter J. D., Sharyn M., Rick I. and David J. H., "Making clinical governance work", British Medical Journal, 329(7467), pp.679-681, 2004. DOI: http://dx.doi.org/10.1136/bmj.329.7467.679
  6. M McClellan, AN McKethan, JL Lewis, J Roski, "A national strategy to put accountable care into practice", Health Aff 29(5), pp.982-990, 2010. DOI: http://dx.doi.org/10.1377/hlthaff.2010.0194
  7. David M. Cutler and Dan P. Ly, "The (Paper)Work of Medicine: Understanding International Medical Costs", The Journal of Economic Perspectives 25(2), pp. 3-25., 2011. DOI : 10.1257/jcp.25.2.3.
  8. Leiyu Shi, "The Impact of Primary Care: A Focused Review", Scientifica vol(2002). Article ID 432892, 22 pages, 2002. DOI: http://dx.doi.org/10.6064/2012/432892
  9. Bruce Hollingsworth, "The measurement of efficiency and productivity of health care delivery", Health Economics 17(10), pp.1107-1128, 2008. DOI: http://dx.doi.org/10.1002/hec.1391
  10. Roblin DW1, Becker ER, Adams EK, Howard DH, Roberts MH., "Patient satisfaction with primary care: does type of practitioner matter?", Med Care 42(6), pp.579-90, 2004. http://www.jstor.org/stable/4640790. https://doi.org/10.1097/01.mlr.0000128005.27364.72
  11. J. Oberlander, and M. J. Laugesen, "Leap of Faith - Medicare's New Physician Payment System", N Engl J Med 373(24), pp.1185-1187, 2015. DOI: http://dx.doi.org/10.1056/NEJMp1509154
  12. Michael E. Porter, "A Strategy for Health Care Reform-Toward a Value-Based System", N Engl J Med 2009(361), pp.109-112, 2009. DOI: http://dx.doi.org/10.1056/NEJMp0904131
  13. KumJa Lee etc., "How to reform Healthcare system of Korea?, KMA Health policy research Center, 2010.
  14. Korean Medical Association, Announcement for the current situation for Korean Primary Care, 2015.9.
  15. YoungHo Oh, "Improvement Ways for Health Care Delivery System", Health and Welfare policy Forum 2012, 49-69.
  16. Jae-Ho Lee, Byung-Su Ko, Jong-Han Leem, Sang-Il Lee, "Standard model and quality appraisal framework for the organization of primary care", JJ. Korean Med Assoc 56(10): 866-880, 2013. http://dx.doi.org/10.5124. https://doi.org/10.5124/jkma.2013.56.10.866
  17. C. Shon, S. Kwon, M. You, "Policy Elites' Perception of Health Policy Governance: Findings from In-depth Interviews of Korean New Diagnosis Related Group Payment", Health Policy and Management 23(4), pp.326-343, 2013. https://doi.org/10.4332/KJHPA.2013.23.4.326
  18. HIRAS, Medical Insurance Payment Data 2015.
  19. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR, Linking primary care performance to outcomes of care, The Journal of Family Practice , 47(3), pp.213-220, 1998, PMID:916752374
  20. Richard E. Rieselbach and Arthur L. Kellermann, "Model Health Care Delivery System for Medicaid", N Engl J Med 2011(364), pp.2476-2478, 2011. DOI: http://dx.doi.org/10.1056/NEJMp1104873
  21. Hyunjin Jeong, Heeyoung Lee, Jae-Ho Lee, Taejin Lee, "Payment reform for the improvement of primary care in Korea", J Korean Med Assoc 56(10), pp.881-890, 2013. DOI: http://dx.doi.org/10.5124/jkma.2013.56.10.881
  22. Dongil O, "A Study on the relations between change of productivity and conversion factor of the Accredited Hospitals based on Malmquist index", Journal of the Korea Academia-Industrial cooperation Society V.12(1), pp.125-137, 2011. DOI: http://dx.doi.org/10.5762/KAIS.2011.12.1.125
  23. Wikipedia, definition of goverance, 2015.3
  24. Y. H. Chung etc., "A Study of Governance on Health Care", Research Paper 2006-02, KIHASA, 2006,.
  25. Dongil O, "A Study on the discriminating of the hospitals based on the efficient insurance conversion factor by AHP and DEA", Journal of the Korea Academia-Industrial cooperation Society V.10(6), pp.1304-1316, 2009. DOI: http://dx.doi.org/10.5762/KAIS.2009.10.6.1304
  26. Stanford Encyclopedia of Philosophy, Kant's Moral Philosophy(substantive revision) Apr 6, 2008