[논문]Investigating the Level of Competition between Public Health Centers and Private Clinics in Korea

김현주; 이진용; 조민우; 은상준

Investigating the Level of Competition between Public Health Centers and Private Clinics in Korea 원문보기

병원경영학회지 = Korea journal of hospital management, v.21 no.2, 2016년, pp.37 - 49

김현주 (신성대학교 간호학과) , 이진용 (서울대학교 보라매병원 공공의료사업단) , 조민우 (울산대학교 의과대학 예방의학교실) , 은상준 (충남대학교 의과대학 예방의학교실)

Abstract ▼ AI-Helper

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

주제어

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문제 정의

Therefore, we decided to investigate the level of competition between private clinics and PHCs. The purpose of this study was to examine how many patients utilized PHCs vs. PCs, to calculate how much money was generated from outpatient services, and finally estimate the financial impacts on PCs due to PHCs.

제안 방법

From this study, we estimated the level of competition between PCs and PHCs using the proportion of visits and the proportion of revenue and calculated the potential financial losses of PCs due to PHCs. PCs and PHCs are the most important players providing primary care in Korea.

대상 데이터

Finally, bundled claims (a healthcare institution can submit a single file of merged claims, called“bundled claimsˮ) were divided into the original individual claims. There were 4,359,907 cases of single claims, which were the subjects of this study[Figure 1]. Each individual claim was designed to represent 100 claims in the 2011 NIS database.

성능/효과

From this study, we had interesting findings that the proportion of Medical Aid recipients utilizing PHCs was 6.2% of total visits, slightly higher than PCs with 5.0% of total visits(P<0.001); and the proportion of patients using PHCs are revenues compared to 22% of visits and revenues in PCs, respectively(P<0.001)[Table 2].
Therefore, the estimated financial losses could be treated as minimum effects. Third, while we estimated the financial losses, we did not judge whether these losses could be serious or acceptable. In order to overcome the limitations of this study, we suggest that some essential follow-up studies should be performed in the near future.

후속연구

First, we need to find the answers regarding who is a primary care physician? or how many local clinics are providing primary care? This will be very difficult but will be an essential process to normalize the primary care in Korea. Second, an in-depth study is need to analyze the characteristics of patients who utilize PHCs. For example, we need to determine who are the vulnerable patients that should be under the care of PHCs.

참고문헌 (19)

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상세보기
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상세보기
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원문보기 상세보기
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상세보기
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Investigating the Level of Competition between Public Health Centers and Private Clinics in Korea 원문보기

Abstract ▼ AI-Helper

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문제 정의

제안 방법

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Investigating the Level of Competition between Public Health Centers and Private Clinics in Korea 원문보기

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