Do differences in profiling criteria bias performance measurements Economic profiling of medical clinics under the Korea National Health Insurance program: An observational study using claims dataReportar como inadecuado




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BMC Health Services Research

, 11:189

Utilization, expenditure, economics and financing systems

Abstract

BackgroundWith a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician-s relative resource use. This study explored the major factors that influence the economic performance rankings of medical clinics in the Korea National Health Insurance NHI program by assessing the consistency between cost-efficiency indices constructed using different profiling criteria.

MethodsData on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic.

ResultsThe exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably.

ConclusionsA medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.

Keywordscost efficiency economic profiling National Health Insurance Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-11-189 contains supplementary material, which is available to authorized users.

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Autor: Hee-Chung Kang - Jae-Seok Hong

Fuente: https://link.springer.com/



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