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.
Health Personnel ; Health Policy ; Humans ; Methods ; Motivation* ; Philosophy ; Quality Improvement ; Quality of Health Care ; Reimbursement, Incentive

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.
*Attitude of Health Personnel ; Humans ; Program Development ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

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.
*National Health Programs ; Program Development ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration/standards ; Republic of Korea

Humans ; Kidney Transplantation ; economics ; Presumed Consent ; Reimbursement, Incentive ; Tissue Donors ; supply & distribution ; Tissue and Organ Procurement ; methods ; standards ; Transplants ; ethics

Strengthening primary care has always been a major policy issue in most developed countries to achieve the health care system's goals, and policy makers continuously try to use payment system as an effective tool to improve overall performance of primary care. In this paper, we examined the various payment methods and growing trends in primary care payment system in some developed countries. Overall, a common form of payment for primary care doctors is a blend of fee-for-service (FFS), capitation, and pay-for-performance (P4P). In addition, many countries are still in the way of many new trials to find the right way to provide primary care service effectively, to meet the complex health care needs of populations. In Korea, primary care system is not well-established, and other institutional arrangements are not in good conditions for primary care, either. FFS, which is a dominant payment method in Korea, is not favorable for achieving good attributes of primary care. Mixing various payment components, like capitation, P4P to current FFS is essential to provide the optimal incentive structures for primary care physicians. Also, new models to encourage doctor-patient relationships with appropriate P4P mechanisms could be used as an early step in reforming primary care payment system gradually.
Administrative Personnel ; Delivery of Health Care ; Developed Countries ; Fee-for-Service Plans ; Humans ; Korea ; Motivation ; Physicians, Primary Care ; Primary Health Care ; Reimbursement, Incentive

Korea has achieved a remarkable expansion in health coverage at modest costs relative to other Organization for Economic Cooperation and Development (OECD) countries. Hospitals are more accessible and equipped with more advanced medical technologies than in most other OECD countries. OECD Reviews of Health Care Quality seek to support the development of better policies to improve the quality of healthcare. In 2012, a report on Korea presented best practices and offered recommendations for improvement in the Korean health system. Korea's health care system needs to shift its focus from simply supporting an ever-continuing expansion of acute care services to quality of healthcare. First, Korea needs to strengthen the focus of governance to the quality of healthcare by establishing HIRA as an institutional champion for quality. Second, Korea must strengthen primary healthcare because in Korea it is woefully underdeveloped today. Third, Korea must use financing to drive improvements in quality of care. In reality, HIRA has used its power over healthcare providers to force them to accept financial constraints; it has not supported quality of all healthcare sectors. Without structural changes allowing for independent judgment on the quality at HIRA, NECA is more suitable for ensuring quality for all healthcare sectors. As suggested by the OECD report, Korea must strengthen primary healthcare by restoring patients' trust in health professionals. In using financing to drive improvements in quality of healthcare, Pay for Performance may be helpful, but that must be driven on a voluntary basis and with a great financial incentive.
Adenosine-5'-(N-ethylcarboxamide) ; Delivery of Health Care ; Health Care Sector ; Health Occupations ; Health Personnel ; Humans ; Judgment ; Korea ; Motivation ; Practice Guidelines as Topic ; Primary Health Care ; Quality of Health Care ; Reimbursement, Incentive