Economic Profiling of Medical Clinics in Korea
Author Information
Author(s): Kang Hee-Chung, Hong Jae-Seok
Primary Institution: Health Insurance Review & Assessment Institute, Health Insurance Review & Assessment Service, Seoul, Republic of Korea
Hypothesis
Do differences in profiling criteria bias performance measurements in economic profiling of medical clinics under the Korea National Health Insurance program?
Conclusion
The profiling criteria used can significantly affect whether a medical clinic is deemed cost-efficient or not.
Supporting Evidence
- The exclusion of pharmacy costs lowered agreement between rankings to the lowest level.
- Differences in case-mix classification also lowered agreement considerably.
- Standardized profiling criteria are important for the consolidated management of health care costs.
Takeaway
This study shows that how we measure costs in clinics can change whether we think they are doing a good job or not.
Methodology
Data on medical care benefit costs for outpatient care were collected from the NHI claims database, and eight types of cost-efficiency indices were calculated and compared.
Potential Biases
Different profiling criteria may lead to contradictory outcomes, affecting the reliability of provider-profiling systems.
Limitations
The time lag between when services are provided and when they are billed could affect the results.
Participant Demographics
The study included 23,112 medical clinics and 22,088,649 patients who visited these clinics.
Digital Object Identifier (DOI)
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