지속가능한 보건의료체계를 위한 지불제도 연구: 묶음지불제 중심으로

Abstract

Korea is undergoing rapid aging, approaching the threshold of becoming an super-aged society by 2025. This demographic shift profoundly impacts the healthcare sector, leading to increased utilization of healthcare services by the aging population and subsequently rising healthcare costs. Additionally, the prevalence of multiple chronic conditions requiring diverse healthcare services is on the rise. This necessitates healthcare system approaches that prioritize people-centered health outcomes and cost-effectiveness. In response to these challenges, various alternative payment models are being explored to address the limitations of traditional payment systems and transition towards a new paradigm of value-based healthcare. One form of alternative payment models is bundled payment. This involves grouping a series of services (episodes) based on health conditions or the interconnectedness of intervention processes, with the goal of paying costs. Bundled payment focuses on promoting collaboration, coordination, quality improvement, and efficiency enhancement as policy objectives. The research examines the domestic payment system and its limitations, and explores extensively bundled payments in the United States, the Netherlands, and the United Kingdom. It proposes the applicability of bundled payment elements-retrospective reconciliation mechanism with target prices, and presents options for domestic adoption. Drawing insights from payment system reforms in other countries, the study proposes strategies for domestic implementation. Successfully transitioning from traditional to innovative payment systems is identified as a significant challenge in the healthcare system. Strategies implemented in countries where payment system reforms have been relatively successful reveals key approaches, including legislative-driven reforms, dedicated organizational establishment, progressive implementation, and increased involvement of healthcare providers. The study underscores the importance of shared accountability for health insurance sustainability among payers, healthcare providers, and users, fostering societal support. This shared accountability increases willingness to accept the uncertainty associated with attempting unfamiliar payment systems compared to familiar ones. The study acknowledges the importance of a dedicated organization to lead systematic payment system reform and the need for cohesive efforts and support from the legislative body. This research contributes by offering specific strategies for adoption of bundled payment in Repulic of Korea and the implementation of payment system reform. It provides practical technical contents for policymakers, healthcare system designers, and researchers aiming to implement bundled payment in Korea. For effective domestic bundled payment application, it is crucial to improve payment accuracy and diagnostic codes should be monitored, with subsequent research on the bundled payment model design and risk adjustment tool development.