Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System
Eunji Yun,1 Hey Jin Ko,2 Boryung Ahn,3 Hyejin Lee,4,5 Won Mo Jang,6,7,* Jin Yong Lee7,8,* 1Division of Pharmaceutical Policy Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 2Division of Healthcare Coverage...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2022-11-01
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| Series: | Risk Management and Healthcare Policy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/expanding-medical-surge-capacity-to-counteract-covid-19-south-koreas-m-peer-reviewed-fulltext-article-RMHP |
| _version_ | 1797990261936095232 |
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| author | Yun E Ko HJ Ahn B Lee H Jang WM Lee JY |
| author_facet | Yun E Ko HJ Ahn B Lee H Jang WM Lee JY |
| author_sort | Yun E |
| collection | DOAJ |
| description | Eunji Yun,1 Hey Jin Ko,2 Boryung Ahn,3 Hyejin Lee,4,5 Won Mo Jang,6,7,* Jin Yong Lee7,8,* 1Division of Pharmaceutical Policy Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 2Division of Healthcare Coverage Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 3Division of Review and Assessment Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 4Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeomggi-do, Republic of Korea; 5Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 6Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; 7Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea; 8Public Health Care Center, Seoul National University Hospital, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Won Mo Jang, Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Dongjak-Gu, Seoul, Republic of Korea, Email thomasj@snu.ac.kr Jin Yong Lee, Public Healthcare Center, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea, Email jylee2000@gmail.comBackground: South Korea has utilized its National Health Insurance (NHI) system to adjust the medical fees payable for healthcare services, to financially support the frontline healthcare providers combating COVID-19. This study evaluated the composition of such adjustments to the medical fees—made to secure resource surge capacity against the pandemic—in South Korea.Methods: Descriptive statistics and schematization were employed to analyze 3,612,640 COVID-19-related NHI claims from January 1, 2020, to June 30, 2021. COVID-19 suspected and confirmed cases were evaluated based on the proportion of fees adjustment, classified into space, staff, or stuff (3S) using diagnosis codes. The proportion of fees adjustment was investigated in terms of the healthcare expenditure, number of patients, and number of healthcare services covered.Findings: First, in terms of cost, medical fee adjustments covered over 96% of the total costs arising from the increased demand for testing (stuff) and isolated spaces among patients suspected of having COVID-19. Second, medical fees were adjusted to cover over 80% of the cost attributable to COVID-19 confirmed cases, in relation to isolated spaces and medical staff support. Third, the adjustment of less than 10% of the various types of medical fees, if selected strategically, can effectively induce a surge in resource capacity.Interpretation: South Korea has improved its existing surge capacity by adjusting the medical fees payable through NHI to healthcare providers. Particularly, through the provider payment system of fee-for-service, the Korean government could prevent the spread of infection and protect the medical staff assigned to respond to COVID-19. However, additional studies on alternative payment systems are needed to control costs while maintaining an effective pandemic response system in the face of the prolonged COVID-19 outbreak.Keywords: COVID-19, resource capacity, medical fees, national health insurance, fee-for-service, provider payment systems |
| first_indexed | 2024-04-11T08:32:43Z |
| format | Article |
| id | doaj.art-cafee89b3f9744a78d73aea8596e8140 |
| institution | Directory Open Access Journal |
| issn | 1179-1594 |
| language | English |
| last_indexed | 2024-04-11T08:32:43Z |
| publishDate | 2022-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Risk Management and Healthcare Policy |
| spelling | doaj.art-cafee89b3f9744a78d73aea8596e81402022-12-22T04:34:26ZengDove Medical PressRisk Management and Healthcare Policy1179-15942022-11-01Volume 152031204279403Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance SystemYun EKo HJAhn BLee HJang WMLee JYEunji Yun,1 Hey Jin Ko,2 Boryung Ahn,3 Hyejin Lee,4,5 Won Mo Jang,6,7,* Jin Yong Lee7,8,* 1Division of Pharmaceutical Policy Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 2Division of Healthcare Coverage Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 3Division of Review and Assessment Research, HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Gangwon-do, Republic of Korea; 4Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeomggi-do, Republic of Korea; 5Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 6Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; 7Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea; 8Public Health Care Center, Seoul National University Hospital, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Won Mo Jang, Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Dongjak-Gu, Seoul, Republic of Korea, Email thomasj@snu.ac.kr Jin Yong Lee, Public Healthcare Center, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea, Email jylee2000@gmail.comBackground: South Korea has utilized its National Health Insurance (NHI) system to adjust the medical fees payable for healthcare services, to financially support the frontline healthcare providers combating COVID-19. This study evaluated the composition of such adjustments to the medical fees—made to secure resource surge capacity against the pandemic—in South Korea.Methods: Descriptive statistics and schematization were employed to analyze 3,612,640 COVID-19-related NHI claims from January 1, 2020, to June 30, 2021. COVID-19 suspected and confirmed cases were evaluated based on the proportion of fees adjustment, classified into space, staff, or stuff (3S) using diagnosis codes. The proportion of fees adjustment was investigated in terms of the healthcare expenditure, number of patients, and number of healthcare services covered.Findings: First, in terms of cost, medical fee adjustments covered over 96% of the total costs arising from the increased demand for testing (stuff) and isolated spaces among patients suspected of having COVID-19. Second, medical fees were adjusted to cover over 80% of the cost attributable to COVID-19 confirmed cases, in relation to isolated spaces and medical staff support. Third, the adjustment of less than 10% of the various types of medical fees, if selected strategically, can effectively induce a surge in resource capacity.Interpretation: South Korea has improved its existing surge capacity by adjusting the medical fees payable through NHI to healthcare providers. Particularly, through the provider payment system of fee-for-service, the Korean government could prevent the spread of infection and protect the medical staff assigned to respond to COVID-19. However, additional studies on alternative payment systems are needed to control costs while maintaining an effective pandemic response system in the face of the prolonged COVID-19 outbreak.Keywords: COVID-19, resource capacity, medical fees, national health insurance, fee-for-service, provider payment systemshttps://www.dovepress.com/expanding-medical-surge-capacity-to-counteract-covid-19-south-koreas-m-peer-reviewed-fulltext-article-RMHPcovid-19resource capacitymedical feesnational health insurancefee-for-serviceprovider payment systems |
| spellingShingle | Yun E Ko HJ Ahn B Lee H Jang WM Lee JY Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System Risk Management and Healthcare Policy covid-19 resource capacity medical fees national health insurance fee-for-service provider payment systems |
| title | Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System |
| title_full | Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System |
| title_fullStr | Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System |
| title_full_unstemmed | Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System |
| title_short | Expanding Medical Surge Capacity to Counteract COVID-19: South Korea’s Medical Fee Adjustment Through the National Health Insurance System |
| title_sort | expanding medical surge capacity to counteract covid 19 south korea rsquo s medical fee adjustment through the national health insurance system |
| topic | covid-19 resource capacity medical fees national health insurance fee-for-service provider payment systems |
| url | https://www.dovepress.com/expanding-medical-surge-capacity-to-counteract-covid-19-south-koreas-m-peer-reviewed-fulltext-article-RMHP |
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