Korean National Health Insurance Value Incentive Program: Achievements and Future Directions

Kim, Sun Min; Jang, Won Mo; Ahn, Hyun Ah; Park, Hyang Jeong; Ahn, Hyo–Suk

doi:10.3961/jpmph.2012.45.3.148

Cited by 27 publications

(21 citation statements)

References 9 publications

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“… B: + 1% (2013)/2% (2017) P: − 1% (2013)/− 2% (2017) per DRG [ 9 , 44 ] VIP P, O AMI: 6 (1) CS: 1 (0) Stroke: 11 (0) AMI: 1.8× AMI: 30% CS: 0% Stroke: 0% Claims data Corrected for age Yes Yes, annual B, P Top 20% overall; top 20% improvement Below threshold (= below 80% best score in Y-2) n.a. First phase: B: +1% on DRG P: − 1% on DRG Second phase B: + 1% on DRG P: − 1% on DRG [ 16 , 45 , 46 ] Broad OBPMs AQC S, P, O pc: 32 (5) sc: 33 (5) pc: 3× sc: 3× pc: 35.7% sc: 34.9% Providers Corrected for age, CD ? Yes, monthly B, SS > Median score; s-shaped relation n.a.…”

Section: Resultsmentioning

confidence: 99%

“…For the narrow OBPMs, five out of nine models showed positive results on the incentivised indicators (CQUIN, HRRP, Maryland HACP, QOF, and VIP) [ 33 , 35 , 40 , 42 , 45 , 54 – 59 ]; one showed mixed results (Hudson health plan) [ 34 , 60 ]; in two models, no significant effect was found (PAMC, VBP) [ 38 , 61 – 64 ]. In the remaining model (HQID), some improvements were observed in the first phase of the programme (first 3 years), but, after some alterations in the design, these improvements did not last [ 9 , 31 , 65 – 68 ].…”

Section: Resultsmentioning

confidence: 99%

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Design and effects of outcome-based payment models in healthcare: a systematic review

et al. 2018

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Introduction Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. Methods We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. Results We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. Discussion Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.Keywords Outcome-based payment models · Health reform · Payment models in healthcare · Health outcomes · Healthcare costs · Quality of care JEL I180

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Design and effects of outcome-based payment models in healthcare: a systematic review

et al. 2018

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“…At this point, some specific privileges were also given to some of the referral hospitals. In 2011, with a positive assessment of the effects of the program, the program was expanded to other hospitals in the country (33).…”

Section: Discussionmentioning

confidence: 99%

“…This is while quality improvement is the first goal reported for the VIP program in Korea and IHA in California. Therefore, quality indicators for services are being measured in hospitals (33,34).…”

Section: Discussionmentioning

confidence: 99%

Designing a Framework for “Iranian Pay for Performance” Program for Non-Medical Workforce in Hospitals

2018

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Introduction: Various pay for performance (PFP) models have been used for different purposes in many countries. The present study aimed to investigate the general framework and feasibility of the PFP program that was implemented in Iran (IR-PFP). Methodology: In 2016, a document analysis was performed to achieve the original framework, and to evaluate its validity with the help of 2 expert panels, and both phases were managed using a four-stage Hermeneutic cycle. Findings:The results of reviewing the documentation revealed that the framework required some prerequisites and determining the PFP of the department and individuals. The expert panels confirmed these 3 components, however, a fourth component namely determining the payment time was added to the model. In addition, the status of the key factors in the design and implementation of the program was reported. Conclusions: The model prerequisites proved helpful in considering the work diversity in hospitals. Furthermore, determining the PFP in 2 stages allowed the inclusion of more indicators in the structure of the program, however, it seems that determining the payment time in 3 months has not been practical for the Iranian health system. The framework has some instruments to strengthen teamwork and decentralize the human resources control and performance measurement in hospitals, however, hospital managers should always be careful about the unwanted side effects.

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“…최근에 역시 심평원이 P4P를 주제로 토론회를 개최한 바 있 다 (Kim, 2011;Lee, 2011). 학술적으로는 예방의학회지에서 2012년 5월에 P4P와 관련한 특집을 다룬 세 편의 논문 (Jeong, 2012;Lee et al, 2012a;Kim et al, 2012) (Thomson et al, 2009 Kingdon (1984Kingdon ( , 1995 (Herd et al, 2010;Robinson et al, 2009;Wagstaff et al, 2009 (Scheffler, 2008).…”

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The Possibility of Expanding Pay-for-Performance Program as a Provider Payment System

Tchoe¹,

Lee²

2013

Health Policy and Management

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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.

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Korean National Health Insurance Value Incentive Program: Achievements and Future Directions

Cited by 27 publications

References 9 publications

Design and effects of outcome-based payment models in healthcare: a systematic review

Design and effects of outcome-based payment models in healthcare: a systematic review

Designing a Framework for “Iranian Pay for Performance” Program for Non-Medical Workforce in Hospitals

The Possibility of Expanding Pay-for-Performance Program as a Provider Payment System

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