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Prospective Payment for Long-term Care Hospitals

Country: 
Südkorea
Partner Institute: 
Department of Health Policy and Management, School of Public Health, Seoul National University
Survey no: 
(11)2008
Author(s): 
Kwon, Soonman
Health Policy Issues: 
Pflege, Vergütung
Reform formerly reported in: 
Prospective Payment for Long-term Care
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja ja nein ja ja nein nein

Abstract

Following the pilot programs from 2005, the Ministry of Health and Welfare implemented a prospective payment system for all long-term care hospitals starting on January 1, 2008. The pilot program has shown that the prospective payment system results in a decrease in cost with little negative effect on the quality of care.

Neue Entwicklungen

Following the pilot programs from 2005 (see HPM report 5/2005), the Ministry of Health and Welfare implemented a prospective payment system for all long-term care hospitals starting on January 1, 2008. Positive results of the evaluation of the pilot programs have led to the decision to implement the prospective payment system for all long-term care hospitals.

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell innovativ innovativ
Kontroversität unumstritten recht kontrovers kontrovers
Strukturelle Wirkung marginal neutral fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig systemneutral systemneutral
current current   previous previous

Since the last report on this topic, it has become more controversial, as the payment was extended from a pilot (voluntarily participating hospitals) to mandatory basis. With rapid population aging, there has also been an increase in public awareness and visibility on long-term care issues. 

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja ja nein ja ja nein nein

Initiators of idea/main actors

  • Regierung
  • Leistungserbringer

Stakeholder positions

Hospitals in Korea are reimbursed by fee-for-service. LT care hospitals were opposed to prospective payment, prefering fee-for-service.

Actors and positions

Description of actors and their positions
Regierung
Ministry of Health and Welfaresehr unterstützendsehr unterstützend stark dagegen
Leistungserbringer
Long-term care hospitalssehr unterstützenddagegen stark dagegen
current current   previous previous

Actors and influence

Description of actors and their influence

Regierung
Ministry of Health and Welfaresehr großsehr groß kein
Leistungserbringer
Long-term care hospitalssehr großneutral kein
current current   previous previous
Ministry of Health and WelfareLong-term care hospitals

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Monitoring and evaluation

The following are the results of the evaluation of the pilot program (report by the Ministry of Health and Welfare). Per-diem cost has decrease by 14% for participating LTC (long-term care) hospitals, from 21,851 Korean Won (KRW) to 18,798 KRW (1 USD is about 950 KRW). There was a big reduction in injections (decrease by 49%). During the same time period, per-diem cost of non-participating LTC hospitals has increased by 1.3%, from 19,642 KRW to 19,892 KRW. The disease categories, for which there was a big reduction in per-diem cost, include malignant neoplasm  (-51.5%), liver cirrhosis (-46.4%), bone disease and arthropathy  (-40.1%), and Alzheimer's disease (-33.7%). 

But there was a change in the distribution of disease categories due to the up-coding of major diagnoses toward greater payment rates. When prospective payment based on diagnosis is introduced, providers have strong incentives to classify patients into diagnoses in higher reimbursement categories. This happened in the prospective payment pilots on Korea. For example, the diagnosis of decubitus ulcer in participating LTC hospitals has increased 847.9 % while it has increased by only 92.7% in non-participating ones. The diagnosis of non-acute diplegia has also increased by 465.4% for participating LTC hospitals while it has decreased by 2.7% for non-participating ones.

However, there was little change in ADL distribution. In prospective payment for long-term care hospitals in Korea, for each diagnosis, there are 3 levels of payment based on ADL(Activities of Daily Living)s (the higher the ADL, the greater the payment). So providers also have an incentive to classify patients (in a given diagnosis) into higher ADL groups. As mentioned above, providers tended to classify patients into diagnoses with greater payment. However, they did not classify patients into higher ADL groups - there was little change in the distribution of ADL.

There was little negative effect of the prospective payment system on provider behavior in terms of perverse substitutions. There was no increase in services paid by fee-for-service (i.e. professional rehabilitation service, medicines for Alzheimer's disease). There was no substitution of un-covered services for ones covered by (social) health insurance.

There was little negative effect of the prospective payment system on quality of care measured by complications, decubitus, necessary medications and tests, management of blood pressure and blood sugar. However, there was a variation in quality measures across LTC hospitals, and it persists. Some LTC hospitals adopt standard practice guidelines after the participation in the pilot program of prospective payment.

Expected outcome

The pilot program showed that the prospective payment for long-term care hospitals decreased the cost of care with little negative effect on substitutions and quality, although there was a creeping (up-coding) by providers. The nation-wide extension of the PPS for all LTC hospitals is expected to contribute to cost containment in LTC hospitals. It is also hoped that PPS pilot program for acute hospitals can be extended to acute hospitals in the near future.

Impact of this policy

Qualität kaum Einfluss relativ starker Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht neutral System gerechter
Kosteneffizienz sehr gering sehr hoch sehr hoch
current current   previous previous

References

Reform formerly reported in

Prospective Payment for Long-term Care
Process Stages: Strategiepapier, Idee

Author/s and/or contributors to this survey

Kwon, Soonman

Empfohlene Zitierweise für diesen Online-Artikel:

Kwon, Soonman. "Prospective Payment for Long-term Care Hospitals". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/rok/a11/2