Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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In Search of Integrated Health Care System Tailored to Korea

한국형 통합의료체계 모형 탐색

  • Shin, Young Seok (Korea Institute for Health and Social Affairs) ;
  • Yoon, Jangho (College of Public Health and Health Science, Oregon State University)
  • Received : 2014.12.12
  • Accepted : 2014.12.23
  • Published : 2014.12.31
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Abstract

This manuscript treats a new paradigm for the Korean health care system. We give an account of innovative health care delivery and payment models widely discussed in the contemporary US accountable care organization and coordinated care organization. In doing so, we explore a new health care model amenable to foreseeable changes to the health care system. We propose creating an integrated health care system in which the network of health care providers delivers coordinated and comprehensive care for enrolled patients residing within the geographic boundaries served by the provider network; providers may participate voluntarily in one or more networks and assume shared responsibility for patient care and cost; provider networks compete with each other based on cost and quality; and consumers are allowed to choose a network. We expect that the new paradigm will create a financially-sustainable system that assures quality of care and improves patient experience, minimizing the existing system-wide inefficiency through cross-network competition and within-network care coordination.

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References

  1. Organization for Economic Cooperation and Development. 2012 OECD health data. Paris: Organization for Economic Cooperation and Development; 2014.
  2. Canada Board of Conference. Measuring success: a framework for benchmarking health care system performance. Ottawa: Canada Board of Conference; 2012.
  3. Shin YS. New paradigm of health care system. Seoul: Korea Institute for Health and Social Affairs; 2012.
  4. Health Insurance Review and Assessment Service. Health care cost for elderly. Seoul: Health Insurance Review and Assessment Service; 2014.
  5. Organization for Economic Cooperation and Development. Looking to 2060: long-term global growth prospects. Paris: Organization for Economic Cooperation and Development; 2012.
  6. Iglehart J. Low-cost, high-quality care in America [Internet]. Bethesda (MD): Health Affairs; 2009 [cited 2014 Dec 4]. Available from: http://healthaffairs.org/blog/2009/07/28/low-cost-high-quality-care-in-america/.
  7. American College of Physicians. Detailed summary: Medicare shared savings/accountable care organization (ACO) program [Internet]. Philadelphia (PA): American College of Physicians; 2011 [cited 2014 Dec 4]. Available from: http://www.acponline.org/running_practice/delivery_and_payment_models/aco/aco_detailed_sum.pdf.
  8. Commonwealth Fund Commission on a High Performance Health System. Why not the best?: results from the national scorecard on U.S. health system performance [Internet]. New York (NY): Commonwealth Fund; 2011 [cited 2014 Dec 4]. Available from: http://www.commonwealthfund. org/-/media/Files/News/Nat%20Scorecard/1500_WNTB_Natl_Scorecard_2011_web.pdf.
  9. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 2003;138(4):288-298. DOI: http://dx.doi.org/10.7326/0003-4819-138-4-200302180-00007
  10. Integrated Healthcare Association. Accountable care organization provisions in the Patient Protection and Affordable Care Act [Internet]. Oakland (CA): Integrated Healthcare Association [cited 2014 Dec 4]. Available from: http://www.iha.org/pdfs_documents/home/IHA_PPACAACOSummary.pdf.
  11. Petersen M, Muhlestein D. ACO results: what we know so far [Internet]. Bethesda (MD): Health Affairs; 2014 [cited 2014 Dec 4]. Available from: http://healthaffairs.org/blog/2014/05/30/aco-results-what-we-know-so-far.
  12. Stecker EC. The Oregon ACO experiment: bold design, challenging execution. N Engl J Med 2013;368(11):982-985. DOI: http://dx.doi.org/10.1056/ NEJMp1214141
  13. Centers for Medicare and Medicaid Services. Accountable care organizations (ACO) [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services [cited 2014 Dec 4]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html.
  14. Centers for Medicare and Medicaid Services. Medicare shared savings program interaction with the physician quality reporting system (PQRS) [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services [cited 2014 Dec 4]. Available from: HYPERLINK "http//www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/PQRS-FAQs.pdf"http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/PQRS-FAQs.pdf.
  15. RTI International. Accountable care organization 2014 program analysis quality performance standards narrative measure specifications [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; 2014 [cited 2014 Dec 4]. Available from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-NarrativeMeasures-Specs.pdf.
  16. Howard SW, Bernell SL, Yoon J, Luck J, Ranit CM. Oregon' experiment in health care delivery and payment reform: coordinated care organizations replacing managed care. J Health Polit Policy Law 2014 Dec 5 [Epub]. DOI: http://dx.doi.org/10.1215/03616878-2854919