|Implemented in this survey?|
The policy of hospital evaluation aims to improve the quality of care by evaluating hospitals and disseminating the results of evaluation. National Review Committee, consisting of consumers, providers (hospital association) and academics and the insurer, is responsible for hospital evaluation. The policy will assess hospital quality based on structural and tangible measures (e.g., staff and facility) and patient satisfaction, not patient outcome measures.
After a few years of pilot program to review hospital quality, the new policy of the evaluation of hospitals is implemented in 2004. The new policy aims to improve the quality of care by assessing
hospital quality and disseminating some of the results.
In 2004, 53 large hospitals with more than 500 beds are being reviewed. National Review Committee, which consists of consumers (civic groups), providers (hospital association) and academics and the insurer (Health Insurance Review Agency), is responsible for the review.
The policy of hospital evaluation will affect hospitals, which can invest more resources in quality improvement. In that case patients benefit from the policy. The impact of the new policy will depend on which dimension of quality and how accurately the quality of care is assessed.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Evaluation of hospital quality is not an innovative idea itself. But the mandatory assessment of private hospital quality by the third party is an important change in the hospital sector in Korea.
Patients are very concerned about quality of care but have difficulty assessing it. Quality of care is of big concern in Korea particularly because private sector dominates the health care delivery (90% of hospitals and 85% of hospital beds are private).
|Implemented in this survey?|
The academic community first generated the idea of the assessment of hospital quality in the national committee for health care reform in 1994. It was based on the concern on patient ignorance and
dissatisfaction on hospital quality.
Previous efforts and pilot programs of hospital quality assessment by the Ministry of Health and Welfare faced strong oppositions by hospitals. Hospitals have maintained that assessment of hospital quality by the Ministry of Health and Welfare is a unnecessary regulation of private sector.
Hospital association maintained that it has a hospital accreditation program for teaching hospital, which has a similar component of quality assessment. Hospital association maintain that if hospital evaluation had to be adopted, it should lead the evaluation. However, there was the public distrust on the role of hospital accreditation program by the hospital association.
The approach of the idea is described as:
renewed: Pilot program decided in the National Committee for Health Care Reform in 1994
Hospital association has strongly opposed to the policy, by arguing that it is unnecessary regulation of the private hospital industry by the government. It has maintained that the assessment of
hospital quality should be the responsibility of hospital association as a form of self regulation.
Ministry of Health and Welfare, the payer (social health insurer), and patients and civic groups have supported the idea of hospital assessment by a public body, by arguing that quality assessment by the hospital association cannot produce and disseminate reliable information on hospital quality.
|Ministry of Health and Welfare||very supportive||strongly opposed|
|Ministry of Health and Welfare||very strong||none|
Because of the strong opposition by the hospital association, the pilot programs of hospital quality assessment, which was administered by the Korean Institute of Health Care Management (now,
renamed to Korea Health Industry Development Institute), stopped in 2000. Instead, the government assessed the quality of 33 public hospitals in 2001.
Since then, discussions and negotiation between the government and providers continued. As a result of negotiation between the government and providers, the new policy of hospital evaluation is not mandated by the Ministry of Health and Welfare (or government institute, i.e., Korea Health Industry Development Institute) but will be the responsibility of a National Review Committee that consists of hospital association, patients and civic groups, and insurer and academics. So the evaluation of hospitals now takes the form of collaboration among government, providers and consumers.
2004 is the first year that the policy is implemented , and the results of this year's review will be available later.
The impact of the evaluation of hospitals on quality improvement will depend on which dimension of quality is measured. The policy will assess hospital quality based on structural and tangible
measures (e.g., staff and facility) and patient satisfaction. Technical difficulties in the accurate measurement (e.g., severity adjustment) as well as strong oppositions by provider groups makes the
policy focus only on input measures of quality rather than patient outcome measures.
Therefore, hospitals may have perverse incentive to focus on structure (input)-based rather than outcome-based quality of care. If hospital structure in terms of more human resources or better (more expensive) facilities leads to better patient outcomes, the new policy will contribute to better health of patients.
The way of disseminating the results of quality review is also of big concern. At least in the initial stage, government plans to disclose only the high-performing group of hospitals as a carrot rather than a stick.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The impact of the policy on quality improvement and hospital competition will depend on which dimension of quality is measured and how the results are disseminated. If hospitals are engaged in competition to invest more in tangible inputs, it may result in health care cost increase, harming the cost-efficiency.
Various documents from the Ministry of Health and Welfare at www.mohw.go.kr