Case-Payment System in Vascular Surgery

Kwak, Hee Yong; Yun, Sang Seob

Abstract

Medical insurance, which is mandatory in Korea, has been progressed in the way of expanding the relevant population and intensifying the guarantee. However, rapid increases in medical expenses led national health insurance into a state of financial crisis. The government considered the reason of financial crisis as fee-for-service and started reorganizing the terms of payment from fee-for-service to case-payment. Therefore, an expanded diagnosis related group (DRG) payment system is carried out to decrease the expense on health and to secure financial stability. At the same time, the new case-payment system, apposite to the medical case in Korean society, is under demonstration. DRG payment system is in execution for the 7 disease entities of the four departments requested for now. However, it is supposed to be carried out in all the hospitals from the second half of 2012 and be expanded to all the general hospitals from 2013. The new case-payment system is under development because it is difficult to apply DRG to all disease entities. These shake-ups in the payment system will be conducted from the year 2015, combining both the DRG and new case-payment system. Basically, the introduction of the new case-payment system will cause doctors' passive attitude in the treatment of patients. This would be an especially serious problem for the department of surgery whose charge for operation is very low. It would be worse for the vascular surgeons because only 80% of operational or interventional procedures will be compensated, the fee for ultrasound is included in the new case-payment system, and age-related severity is not reflected in the disease entity. If relaunch is inevitable, vascular surgeons should understand the new case-payment system exactly and point out the problems. Also, standard guidelines on treatment per procedure should be set up and used for the established case-payment system, which would be helpful in reducing unnecessary medical expenses.