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A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework
Marita Mohammadshahi, Shahrooz Yazdani, Alireza Olyaeemanesh, Ali Akbari Sari, Mehdi Yaseri, Sara Emamgholipour Sefiddashti
J Prev Med Public Health. 2019;52(2):72-81.   Published online December 31, 2018
DOI: https://doi.org/10.3961/jpmph.18.238
  • 13,798 View
  • 270 Download
  • 9 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions.
Methods
This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework.
Results
The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage.
Conclusions
A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.
Summary

Citations

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Special Articles
Korean National Health Insurance Value Incentive Program: Achievements and Future Directions
Sun Min Kim, Won Mo Jang, Hyun Ah Ahn, Hyang Jeong Park, Hye Sook Ahn
J Prev Med Public Health. 2012;45(3):148-155.   Published online May 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.3.148
  • 9,918 View
  • 101 Download
  • 26 Crossref
AbstractAbstract PDF

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

Summary

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Designing an Effective Pay-for-performance System in the Korean National Health Insurance
Hyoung-Sun Jeong
J Prev Med Public Health. 2012;45(3):127-136.   Published online May 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.3.127
  • 16,106 View
  • 95 Download
  • 7 Crossref
AbstractAbstract PDF

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

Summary

Citations

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    BMJ Open.2016; 6(4): e009538.     CrossRef
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JPMPH : Journal of Preventive Medicine and Public Health