|Implemented in this survey?|
Prospective payment system was recently developed for long-term care, based on daily rates for 17 disease groups. Each disease group is further classified into three functional status relying on the ADL(Activities of Daily Living)s, leading to 51 daily rates in total. The new payment system will be implemented as a pilot program for voluntarily participating long-term care hospitals.
Due to population aging, health care expenditure of long-term care has increased rapidly. There is no long-term care insurance system, and health insurance currently applies fee-for-service
payment to both acute and long-term care. Fee-for-service payment is not adequate to take into account the unique characteristics of long-term care patients and provides perverse incentives for
hospitals to increase the amount of services, contributing to cost inflation of the national health insurance.
Ministry of Health and Welfare and Health Insurance Review Agency recently developed prospective payment system for long-term care. It is based on daily rates for 17 disease groups. Each disease group is further classified into three functional status relying on the ADL (Activities of Daily Living)s, leading to 51 daily rates in total.
To reduce health care costs associated with long-term care.
Financial: payment to long-term care hospitals.
Long-term care hospitals, Long-term care patients
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Degree of controversy and public visibility was low in the policy process associated with the development of the new payment system because it has been led by experts.
|Implemented in this survey?|
The inefficiency of fee-for-service payment for long-term care has been well recognized. Daily rate is a more adequate method of paying for long-term care because health care needs of long-term
care patients are more or less stable. Daily rate also needs to take into account the functional status of patients, which determines the utilization of resource and personnel.
It took a year for the Health Insurance Review Agency (HIRA), public agency for claim review and research under the national health insurance (NHI), with the support of the Ministry of Health and Welfare, to develop prospective payment system for long-term care.
The classification of disease types into 17 categories is similar to the RUG (Resource Utilization Group) system used in the Medicare and Medicaid in the U.S. There are 3 types of cases, depending on functional status of the patient, per each of 17 disease categories. Therefore the prospective payment for long-term care has 51 different daily rates.
But payment to long-term care hospitals is not entirely prospective. In order to avoid the potential negative effect of the prospective payment on the quality of care, fee-for-service is used for professional rehabilitation service and medicines for Alzheimer's disease.
The approach of the idea is described as:
Long-term care hospitals have not been supportive of the idea of prospective payment for them. However, there are only about 100 long-term care hospitals in Korea, most of them are small in size,
and they are not yet strong stakeholders to have a strong influence on government policy.
The consensus on prospective payment for long-term care has been much stronger than that for acute care. (Due to strong oppositions by physicians, prospective payment for acute care has not been implemented in Korea.) A large proportion of long-term care has social care aspect, and the role of medical profession in long-term care settings is much smaller than in acute care.
|Ministry of Health and Welfare||very supportive||strongly opposed|
|Health Insurance Review Agency||very supportive||strongly opposed|
|Ministry of Health and Welfare||very strong||none|
|Health Insurance Review Agency||very strong||none|
Pilot program for voluntarily participating long-term care hospitals will be implemented in May 2005.
The pilot program will include an evaluation system that monitors the amount of services provided, number of inpatient days, potential change in coding, patient selection, patient and provider satisfaction, and the quality care.
Prospective payment system for long-term care is expected to contribute to the containment of the costs of long-term care hospitals. However, providers may change their behavior to maximize reimbursement under the new payment system, such as increasing the number of inpatient days, coding change toward greater reimbursement, selection of patients who consume relatively smaller amount of resources per given case, sacrifice of quality by not providing necessary care, etc. Close monitoring and evaluation of the pilot program will be essential to the nation-wide implementation of the prospective payment system for long-term care.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The desired impact of the prospective payment system for long-term care is to improve cost-efficiency with the maintenance of quality of care in long-term care hospitals.