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Provision of Information on Providers to Consumers

Country: 
South Korea
Partner Institute: 
Department of Health Policy and Management, School of Public Health, Seoul National University
Survey no: 
(6)2005
Author(s): 
Soonman KWON
Health Policy Issues: 
Quality Improvement
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no yes no no

Abstract

Ministry of Health and Welfare and Health Insurance Review Agency announced the lists of providers, which showed low rate of prescription of injectable drugs, low utilization of caesarean section, and low prescription rate of antibiotics for acute upper respiratory infection, respectively. The dissemination of information on provider performance on overuse or misuse of medical care will help consumers make rational choice of providers, leading to the change in provider behaviour.

Purpose of health policy or idea

By providing information on the performance of medical care providers to consumers, this policy intends to empower consumers and change provider behavior. Over-use of inappropriate types of medical care has caused serious concerns to the health insurer and government, particularly in the area of caesarean section, antibiotics and injectable drugs.

Ministry of Health and Welfare and the Health Insurance Review Agency recently announced the lists of health care providers and institutions, which showed low rate of prescription of injectable drugs, low utilization of caesarean section, and low rate of prescription of antibiotics for acute upper respiratory infection, respectively. The lists are available at the website of the Health Insurance Review Agency.

Consumer ignorance is one of main causes of market failure in the health care sector. Providing information on medical care providers can help consumers make rational choice of providers. As a result of consumer empowerment and informed choice, providers are expected to change their clinical decision in a desired direction, and the provision of inappropriate medical care is reduced.

Main points

Main objectives

To change provider behavior and improve efficiency in health care delivery.

Type of incentives

Non-financial incentives.

Groups affected

Medical care providers, Cosnumers, Health insurer

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low high very high
Transferability strongly system-dependent system-neutral system-neutral

Political and economic background

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no yes no no

Origins of health policy idea

Health Insurance Review Agency of the national health insurance system in Korea reviews the claims made by medical care providers for reimbursement. Besides the claim review for the purpose of cost containment, the agency is also concerned about the appropriateness of medical care provided.

Over-prescription of injectable drugs and antibiotics and the overprovision of caesarean section are the typical examples of inappropriate use of medical care in Korea, which cannot be justified on the basis of both clinical and economic considerations. Variation among medical providers is also very high for those 3 services.

In 2003, prescription rate of injectable drugs in the outpatient care is 13.8% for general hospitals, 31.8% for hospitals and 32.3% for physician clinics. C-section rate in Korea was 40.5% in 2001 and 38.1 in 2004. Prescription rate of antibiotics for acute upper respiratory infection was 64.2% in 2002 and 57.8% in 2004 for physician clinics.

Initiators of idea/main actors

  • Government

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Providers did not support the policy of disseminating information on providers to consumers. However they were not strongly opposed to the policy for two reasons. First, the overuse of injectable drugs and antibiotics and C-section was so serious that they had to acknowledge that thier overutilization needs to be reduced.

Second, the policy of information dissemination has the naure of carrot rather than punishment in the sense that Health Insurance Review Agency provides the list of health care institutions with low rates of injectable drug/antibiotics prescription or low rates of C-section delivery, rather than those with high rates of utilization/provision. Due to the potential problem of the difference in case mix or patient seveity of illness, dissemination of the utilization of injectable drugs/antibiotics and C-section for every health care institution is neither possible nor desirable.

Actors and positions

Description of actors and their positions
Government
Ministry of Health and Welfarevery supportivevery supportive strongly opposed
Health Insurance Review Agencyvery supportivevery supportive strongly opposed

Actors and influence

Description of actors and their influence

Government
Ministry of Health and Welfarevery strongvery strong none
Health Insurance Review Agencyvery strongstrong none
Health Insurance Review AgencyMinistry of Health and Welfare

Positions and Influences at a glance

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

Adoption and implementation

Health Insurance Review Agency played a leading role in the policy process. Because it reviewed the medical utilization data for review, it understands the seriousness of the over-provision of injectable drugs, antibiotics and C-sections. Sometimes there were news media coverage of the problems associated with over-utilization of those services in Korea. Some civic groups paid attention to the issue and supported the policy.

In May, 2005, Ministry of Health and Welfare (MOHW) and Health Insurance Review Agency (HIRA) announced the list of 145 hospitals and 5,138 physician clinics that are in the lower 25 percentile of providers in terms of the prescription rate of injectable drugs in 2004.

In September, 2005, MOHW and HIRA announced the list of 179 health care institutions that are in the lower 25 percentile of providers in terms of the C-section rate in 2004. In order to account for the difference in patient severity of illness, the HIRA, with the consultation of the Korean Society for Obstetrics and Gynecology, developed a risk-adjusted C-section rate, taking into account the age, complications, diadnosis of other diseases, bleeding and other risk factors.

In October 2005, MOHW and HIRA announced the list of 2,603 physician clinics that are in the lower 25 percentile in the prescription rate of antibiotics for acute upper respiratory infection. All those lists are available in the website of the HIRA.

Expected outcome

Provision of information to consumers on the performance of medical care providers can tackle the fundamental sources of the imperfection of the health care market, i.e., information asymmetry between the provider and consumer. The new policy of dissemination information to consumers is expected to spur on many policy measures to empower consumers and help them make rational decisions rather than directly regulating medical providers. It will also be worthwhile to monitor the impact on provider behaviour of the information dissemination, i.e., whether those providers associated with over-provision indeed change their behaviour and reduce appropriate medical care. 

Impact of this policy

Quality of Health Care Services marginal fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low very high very high

References

Sources of Information

www.hira.or.kr

www.mohw.go.kr

Author/s and/or contributors to this survey

Soonman KWON

Suggested citation for this online article

Soonman KWON. "Provision of Information on Providers to Consumers". Health Policy Monitor, Oct 2005. Available at http://www.hpm.org/survey/kr/a6/2