Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
권호 표지

Investigating the Level of Competition between Public Health Centers and Private Clinics in Korea

  • Kim, Hyun Joo (Department of Nursing Science, Shinsung University) ;
  • Lee, Jin Yong (Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Jo, Min-Woo (Department of Preventive Medicine, University of Ulsan College of Medicine) ;
  • Eun, Sang Jun (Department of Preventive Medicine, Chungnam National University School of Medicine)
  • 김현주 (신성대학교 간호학과) ;
  • 이진용 (서울대학교 보라매병원 공공의료사업단) ;
  • 조민우 (울산대학교 의과대학 예방의학교실) ;
  • 은상준 (충남대학교 의과대학 예방의학교실)
  • Received : 2016.01.26
  • Accepted : 2016.06.03
  • Published : 2016.06.30
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Abstract

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

Keywords

References

  1. Lee JY, Jo MW, Yoo WS, Kim HJ, Eun SJ. Evidence of a broken healthcare delivery system in Korea: Unnecessary hospital outpatient utilization among patients with a single chronic disease without complications. J Korean Med Sci 2014;29(12):1590-1596. https://doi.org/10.3346/jkms.2014.29.12.1590
  2. Ock MS, Kim JE, Jo MW, Lee HJ, Kim HJ, Lee JY. Perceptions of primary care in Korea: A comparison of patient and physician focus group discussions. BMC Family Practice 2014;15:178. https://doi.org/10.1186/s12875-014-0178-5
  3. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan 2009;24: 63-71.
  4. Chun CB, Kim SY, Lee JY, Lee SY. Republic of Korea: Health system review. Health Syst Transit 2009;11:1-184.
  5. Song YJ. The South Korean health care system. Japan Med Assoc J 2009;52:206-209.
  6. Jo HS. Strategies for improvement of primary care in Korea. J Korean Med Assoc 2012;55(10): 959-968. https://doi.org/10.5124/jkma.2012.55.10.959
  7. Shin ST. Interdisciplinary approach between health centers and private hospitals/clinics. J Korean Med Assoc 2004;47(12):1140-1143. https://doi.org/10.5124/jkma.2004.47.12.1140
  8. Sung CH. Community based primary care demonstration. Health Policy Forum 2013;11(4): 37-42.
  9. Kim YG. Dying healthcare institution, what are causes and how to respond?: prospects and coordinates in healthcare delivery system. Health Policy Forum 2012;10(2):16-23.
  10. Lee JY, Eun SJ, Ock MS, Kim HJ, Lee HJ, Son WS, Jo MW. General Internists' perspectives regarding primary care and currently related issues in Korea. J Korean Med Sci 2015;30(5): 523-532. https://doi.org/10.3346/jkms.2015.30.5.523
  11. Kim L, Sakong J, Kim Y, Kim S, Kim S,Tchoe B, Jeong H, Lee T. Developing the inpatient sample for the National Health Insurance claims data. Health Policy and Management 2013;23(2): 152-161. https://doi.org/10.4332/KJHPA.2013.23.2.152
  12. Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014; 36:e2014008. doi: 10.4178/epih /e2014008.
  13. http://kosis.kr/statisticsList/statisticsList_01List. jsp?vwcd=MT_ZTITLE&parentId=D#SubCont
  14. Choi JW. Dying healthcare institution, what are causes and how to respond?: the cause of crisis and response in terms of healthcare system. Health Policy Forum 2012;10(2):24-29.
  15. Han KT, Park EC, Kim SJ. Unmet healthcare needs and community health center utilization among the low-income population based on a nationwide community health survey. Health Policy 2016 Apr 14. [Epub ahead of print] pii: S0168-8510(16)30081-1. doi:10.1016/j.healthpol.2016.04.004.
  16. Park KD. Primary Care Physician in Korea. J Korean Acad Fam Med 2002;23(6):677-687.
  17. Ahn SH. Assessment of primary care level in Korea and comparison with the developed countries. J Korean Acad Fam Med 2001;22(4): 483-497.
  18. Organization for Economic Cooperation and Development. OECD Healthcare Quality Review: Korea, Assessment and Recommendation. Organization for Economic Cooperation and Development. 2012. [http://www.oecd.org/korea/49818570.pdf]
  19. Jo WM. Dying healthcare institution, what are causes and how to respond?: the current status and future strategies of private clinics Health Policy Forum 2012;10(2):36-41.