J Korean Med Assoc.  2012 Feb;55(2):187-197. 10.5124/jkma.2012.55.2.187.

Patient assessment of primary care under the Designated Practice Scheme for Medical Aid beneficiaries, using the Korean Primary Care Assessment Tool (K-PCAT): a district of Seoul, South Korea

• Lee JH
• Choi YJ
• Choi JS
• Kim S

• KMID: 2192666
• DOI: http://doi.org/10.5124/jkma.2012.55.2.187

Abstract

To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (> or =3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.

Keyword

Primary health care; Quality assurance; Medical aid; Republic of Korea

MeSH Terms

Confounding Factors (Epidemiology)
Delivery of Health Care
General Practice
Humans
Intention
Internal Medicine
Multivariate Analysis
Primary Health Care
Republic of Korea

Reference

1. Shin HW, Shin YS, Whang DK, You WS, Choi KC, Lim SJ. Monitoring the designated medical institution program for Medical Aid beneficiaries. 2008. Seoul: Korea Institute for Health and Social Affairs.

2. National health insurance statistics [Internet]. National Health Insurance Corporation; Health Insurance Review & Assessment Service. 2001-2010. Seoul: National Health Insurance Corporation; Health Insurance Review & Assessment Service;Available from: http://www.bokjiro.go.kr/data/statusList.do.

3. National medical aid statistics [Internet]. National Health Insurance Corporation. 2001-2010. cited 2012 Jan 17. Seoul: National Health Insurance Corporation;Available from: http://www.nhic.or.kr/portal/site/main/menuitem.ca795eeeeb35fa404bf15151062310a0.

4. Shin HW, Shin YS, Yoon SJ, Kim S, Choi JS. Introduction plan of the designated medical institution program and co-payment system for Korean Medical Aid beneficiaries. 2007. Seoul: Korea Institute for Health and Social Affairs.

5. Kim S, Choi JS, Ju JS, Choi MY, Yang JH, Chae JM. Evaluation of the effect and the improvement plan of the designated medical institution system for Medical Aid beneficiaries. 2010. Seoul: Health Insurance Review & Assessment Service.

6. Lee WH. Development plan for medical service and health maintenance of Medical Aid beneficiaries [dissertation]. 2006. Seoul: Hanyang University.

7. Kim ES, Nam JJ, Kim MY, Ko IS, Lee DM, Kim KS, Choi JS, Park HJ, Shin SM, Lee SH, Yang IS. Status that long-term users of medical aid use medical service, and its improvement plan. 2007. Seoul: Ministry of Health and Welfare.

8. Samarasekera U. Margaret Chan's vision for WHO. Lancet. 2007. 369:1915–1916.

9. Ko IS, Lee TW, Lee KJ, Lee JL, Choi JS, Lee SK, Kim JA, Lee MR. Case management networks for effective management of health care in the low income people. 2006. Seoul: Ministry of Health and Welfare.

10. Lee JH, Choi YJ, Sung NJ, Kim SY, Chung SH, Kim J, Jeon TH, Park HK. Korean Primary Care Research Group. Development of the Korean primary care assessment tool-measuring user experience: tests of data quality and measurement performance. Int J Qual Health Care. 2009. 21:103–111.

11. National Health Insurance Corporation. Effectiveness assessment in primary care. 2008. Seoul: National Health Insurance Corporation.

12. Choi YG, Kim K, Choi YJ, Sung NJ, Kim J, Park JH, Hong SK, Lee JH. Korean Primary Care Research Group. Patient assessment of primary care of health cooperative clinics in South Korea. Korean J Fam Med. 2010. 31:765–777.

13. Sung NJ, Suh SY, Lee DW, Ahn HY, Choi YJ, Lee JH. Korean Primary Care Research Group. Patient's assessment of primary care of medical institutions in South Korea by structural type. Int J Qual Health Care. 2010. 22:493–499.

14. Park JH, Kim KW, Sung NJ, Choi YG, Lee JH. Korean Primary Care Research Group. Association between primary care quality and health behaviors in patients with essential hypertension who visit a family physician as a usual source of care. Korean J Fam Med. 2011. 32:104–111.

15. Jung JW, Sung NJ, Park KH, Kim SW, Lee JH. Patient's assessment of community primary and non-primary care physicians in Seoul city of South Korea. Korean J Fam Med. 2011. 32:226–233.

16. Care coordination measures atlas [Internet]. Agency for Healthcare Research and Quality. 2010. cited 2011 Dec 10. Rockville (MD): Agency for Healthcare Research and Quality;Available from: http://www.ahrq.gov/qual/careatlas/careatlas.pdf.

17. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005. 83:457–502.

18. Starfield B. Primary care: balancing health needs, services, and technology. 1998. New York: Oxford University Press.

19. Lee JH, Choi YJ, Volk RJ, Kim SY, Kim YS, Park HK, Jeon TH, Hong SK, Spann SJ. Defining the concept of primary care in South Korea using a Delphi method. Fam Med. 2007. 39:425–431.

20. Cho HJ. The prospect of QA in primary care. J Korean Acad Fam Med. 1994. 15:847–856.

21. Quality and outcomes framework: online GP practice results database [Internet]. 2011. cited 2011 Dec 13. London: The Health and Social Care Information Centre;Available from: http://www.qof.ic.nhs.uk/.

22. Practice Incentives Program (PIP) [Internet]. 2011. cited 2011 Dec 13. Canberra: Department of Human Services, Australian Government;Available from: http://www.medicareaustralia.gov.au/provider/incentives/pip/index.jsp.

23. Patient-Centered Medical Home [Internet]. 2011. cited 2011 Dec 13. Washington, DC: National Committee for Quality Assurance;Available from: http://www.ncqa.org/tabid/631/Default.aspx.

24. DeVoe JE, Saultz JW, Krois L, Tillotson CJ. A medical home versus temporary housing: the importance of a stable usual source of care. Pediatrics. 2009. 124:1363–1371.

25. Blewett LA, Johnson PJ, Lee B, Scal PB. When a usual source of care and usual provider matter: adult prevention and screening services. J Gen Intern Med. 2008. 23:1354–1360.

26. O'Malley AS, Mandelblatt J, Gold K, Cagney KA, Kerner J. Continuity of care and the use of breast and cervical cancer screening services in a multiethnic community. Arch Intern Med. 1997. 157:1462–1470.

27. Kim JH, Cho HJ. Effects of having regular source of care on preventive services and disease control. J Korean Acad Fam Med. 2007. 28:278–285.

28. Schoen C, Osborn R, Huynh PT, Doty M, Davis K, Zapert K, Peugh J. Primary care and health system performance: adults' experiences in five countries. Health Aff (Millwood). 2004. Suppl Web Exclusives:W4-487–W4-503.

29. Osborn R. Comparing health care systems performance: opportunities for learning from abroad [Internet]. 2008. cited 2011 Dec 13. Washington, DC: Alliance for Health Reform;Available from: http://www.allhealth.org/briefingmaterials/osborn-1189.ppt.

30. Jung YH. A report on the Korea Health Panel Survey: health care utilizations and out-of-pocket spending. Health Welf Policy Forum. 2011. 179:64–82.