ScholarWorks@중앙대학교

초록

Background Health care payment systems are a central component of health reform efforts worldwide, as they shape provider behavior, financial sustainability, and access to care. The Korean government plans to change the payment system for medical expenses from the existing fee-for-service system to an alternative system such as pay-for-performance and value-based payments. This study aims to compare the perceptions of clinic-and hospital-based physicians regarding the reform agenda and draw lessons relevant to international health policy contexts. Methods This study used the member data from the Korean Medical Association to conduct an online survey of physicians. In total, 765 physicians participated in the final analysis. The differences in perceptions between physicians working in clinics and hospitals were examined using cross-tabulation analyses and Pearson's chi-squared tests. Results According to the results of a survey on awareness of the government's planned payment system reform, doctors from clinics (94.8%) and hospitals (87.5%) responded that the reform would not contribute to improving the quality of medical care or reducing medical costs (P < 0.001). In addition, as a result of investigating the domestic applicability of payment models, such as the Accountable Care Organization (ACO), many doctors in both clinics (60.2%) and hospitals (57.8%) responded that the ACO model was not applicable (P = 0.001). The most frequently cited reason for the difficulty in applying the ACO model was ""uncertainty about its performance and effectiveness,""; however, there was no significant difference between hospitals and clinics (P > 0.05).The fee-for-service system (81.1% of clinics, 73.8% of hospitals) and performance-based payment system (24.7% of clinics, 36.6% of hospitals) were the preferred payment systems suitable for future clinics and hospitals. Conclusion This study confirmed that both clinic and hospital doctors had a negative perception of the government's proposed payment system reform. When introducing a new payment system, it is necessary to analyze its impact on doctors and patients in detail and devise alternatives that reflect this. Particularly, it would be effective to design a structure that provides appropriate compensation so that the payment method does not hinder the quality and equity of medical care.

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