J Korean Med Sci.  2012 May;27(Suppl):S25-S32. 10.3346/jkms.2012.27.S.S25.

Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

• Kim YK

• KMID: 1714485
• DOI: http://doi.org/10.3346/jkms.2012.27.S.S25

Abstract

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

Keyword

National Health Insurance; Reimbursement System; Fee-for-service Payment; DRG-Based Payment; Global Budget Payment; Neo-KDRG-Based Payment

MeSH Terms

*Budgets
Delivery of Health Care/economics
Diagnosis-Related Groups
Efficiency, Organizational/economics
Fee-for-Service Plans/economics
Forecasting
Humans
*Insurance, Health, Reimbursement
National Health Programs/*economics
Republic of Korea

Figure

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  Fig. 1 Annual trend of cost of insured medical care for healthcare institutions and pharmacies in Korea. Source: National Health Insurance Corporation (NHIC), Statistical Yearbook.

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  Fig. 2 Transition of reimbursement methods in Korea.

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  Fig. 3 Determination of relative value scale and conversion factor for reimbursement in Korea.

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