Primary Care Patients’ Preference for Hospitals over Clinics in Korea

Abstract

Korea is in a unique condition to observe whether patients, when equal access to the levels of health care facilities is guaranteed by the support of the national health insurance, choose the appropriate levels of health care facilities. This study was performed to investigate the primary care patients’ preference for hospitals over clinics under no restriction for their choice. We used the 2011 National Inpatient Sample database of the Health Insurance Review and Assessment Service in Korea. A primary care patient was defined as a patient who visited as an outpatient in health care facilities with one of the 52 minor conditions defined by the Korean government. We found that approximately 15% of outpatient visits of the patients who were eligible for primary care in Korea happened in hospitals. In terms of cost, the outpatient visits in hospitals accounted for about 29% of total cost of outpatient visits. This arbitrary access to hospitals can lead to an inefficient use of health care resources. In order to ensure that health care facilities are stratified in terms of access as well as size and function, interventions to distribute patients to the appropriate level of care are required.

Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study

“…[18] The strength of the Korean primary care system was reported as the weakest among the Organisation for Economic Cooperation and Development (OECD) countries. [19] Many unique features of the Korean context have hindered the establishment of a primary care system, including the nominal patient referral system without a gatekeeping function, [17,[20][21][22][23] fee-for-service schedule, [18] overproduction of specialists and sub-specialties, [20,24] and private sector dominance. [22] Hospitals in Korea operate large-scale outpatient units, providing primary care as well as secondary/tertiary care services.…”

“…[22] Hospitals in Korea operate large-scale outpatient units, providing primary care as well as secondary/tertiary care services. [21] Due to the absence of functional gatekeeping (virtually equivalent to direct access to hospitals), [23,24] hospital ambulatory care has been over-utilized, and many hospitals in turn have expanded their outpatient units. [21] Furthermore, their intensive use of expensive technology and over-provision of treatment services have burdened the National Health Insurance system, [6,16,17,25] undermining efficiencies in health expenditure and equity in resource allocation.…”

“…[21] Furthermore, their intensive use of expensive technology and over-provision of treatment services have burdened the National Health Insurance system, [6,16,17,25] undermining efficiencies in health expenditure and equity in resource allocation. [16] Previous studies estimated that at least 15% to 33% of hospital outpatient visits were deliverable in primary care facilities, [24,26] and 29% of the national expenditure on ambulatory care was for the hospital sector. [24] Consequently, Korea has experienced one of the highest rates of health expenditure increases among OECD countries.…”

“…[16] Previous studies estimated that at least 15% to 33% of hospital outpatient visits were deliverable in primary care facilities, [24,26] and 29% of the national expenditure on ambulatory care was for the hospital sector. [24] Consequently, Korea has experienced one of the highest rates of health expenditure increases among OECD countries. [16] To overcome these problems, reforming health systems to make better use of resources is crucial.…”

The Primary Care Performance of Three Types of Medical Institutions: A Public Survey using the Korean Primary Care Assessment Tool

“…Moreover, South Koreans generally prefer hospitals to local clinics because they believe that the quality of care that is provided by hospitals is better than that of local clinics, even with regard to basic care [7][8]. As a result, patients who require only basic outpatient care also visit hospitals; thus, a large proportion of the outpatient services of hospitals are devoted to primary care [9]. It has recently been reported that many other countries are facing a similar situation and struggling to find a way to ease the herd behaviors of their patients [10][11][12][13][14].…”