Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
2. 연자 소개
• 서울와이즈요양병원 원장現
• 눔 전략現 / 의학 자문
• 삼성서울병원 의료관리학과 임상조교수前
• 前 McKinsey & Company, 컨설턴트
• 서울대병원 내과 전공의前 , 내과 전문의
• 연세대학교 보건대학원 보건학 석사
• 서울대학교 의과대학 의학사
3. OVERVIEW OF THE SOUTH KOREAN HEALTH SYSTEM
Financing
• System financed through National Health Insurance system (NHIS)
• Low-contribution, low-benefit model
– Privately funded expense constitutes ~45% of total medical bill
– Certain areas are not covered (e.g. MRI, Ultrasound, Private room)
– NHIS covers 40~70% of outpatient and 80% of inpatient healthcare spending
– Overall fees for covered items are set low compared to other countries
Role of
government
• Government has very strong influence on healthcare policies, price setting,
clinical guideline review and reimbursement decisions
• Doctors show distrust for the government
Access
• Universal care – 100% coverage by mandatory national insurance system
• No major issue on physician or nurse coverage although on specific areas have
physician shortages
• Walk-in patients only have to wait 15~30 minutes to see doctors
Providers
• >70% of the hospitals are private, however, all hospitals are not-for profit by law
• 3 tier system but no real gate keeping system with large number of clinics and
strong preference for leading tertiary hospitals in Seoul
• Mandatory subscription to National Health Insurance & fee for service
• ~95% of doctors are specialists
• Only full-time employees at hospitals can practice there
A
B
4. Korean people pay a large portion of medical bill and have
contradictory expectation for medical practice
Major reasons for dissatisfaction
with medical system
• Top 3 reasons for dissatisfaction
- Cost
- Waiting time
- Treatment outcome
• The reasons show that people want
more from medicine, while they are
not willing to pay more
Privately-funded medical expense is
~34% of total medical bill
Given that Korean medical system
has shown excellent outcome,
dissatisfaction with treatment
outcome is more about the
process
A
5. Worsening balance of NHIS has made government introduce various
initiatives for health management service
Committee on NHIS policy Case examples
• Composition: 25 members
- Chair: vice-minister of MHW
- Member representatives: employer/
employee (2), civic/consumer/agri-
fishery/self-employed (1)
- Provider representatives: AMA (2), AHA/
dentistry/oriental/nurse/pharmacy/pharmaceu
tical (1)
- Public representatives (8)
• Government controls public representative
group and cooperates with member
representatives to suppress fee rise
• Populistic approach
- Abolishment of children’s hospitalization fee
- Start covering fees for hospital food
• Government rule constrains medical practice
- Cannot prescribe chemotherapeutic agents
for a patient whose condition is outside of
indication
- Number of coronary stents that can be used
for a patient over his/her lifetime is limited
B
6. Doctors in general have distrust for government but different
groups have different agenda
•Reasons for distrust
• Medical fee set low (it is said to be below cost)
• Inconsistency in insurance reimbursement
• Gov’t not respecting experts’ opinion
•Distrust is strongest among clinic doctors
•Composition of doctors by employment
• ~1/3 self-employed clinic doctors
• ~1/3 employees
• ~1/6 trainee (interns, residents)
• ~1/8 professors
•Korean Hospital Association(KHA) is as strong as Korean Medical
Association(KMA)
B
7. Landscape of Korean healthcare system
•Korean doctors and hospitals have sought volume business &
focus on uncovered areas
•Hospitals have waged arms race, which destroyed bases for clinics
•There is no proper system for education programs and care
services
•Due to expected worsening balance of NHIS, government tries to
introduce various initiatives for health management service.
Private insurance companies have similar needs
•Korean Hospital Association(KHA) is as strong as Korean Medical
Association(KMA)
1
2
3
4
8. Korean doctors and hospitals have sought volume business to
overcome low medical fee
As medical fee is lower in Korea
compared to other countries…
…Korean doctors and hospitals make up by
increasing the volume of medical care
Outpatient
consultation
time averages
3~5 minutes,
and physicians
need to see
more than 70
patients per
day to be
profitable
1
9. and focus on uncovered areas, where they can charge freely, and
ancillary services
Ancillary services
• Ancillary services such as funeral hall,
parking lots, restaurants, retail stores etc.
are allowed by law
• Revenue from those services make up for
the losses incurred by providing covered
services
Uncovered areas
• MRI
- Most of MRI scans were not covered by
NHIS (, which has changed)
- Among OECD countries, Korea ranks 4th
with regards to number of MRI machines
per capita (Japan, US, Italy)
• Premium health check-up
- With margin of 30~40%, premium health
check is a lucrative biz for major hospitals
- Cost at major Big4 hospitals averages
$800~1,000 and goes up to $20,000 for
VIP services
• Plastic surgery, Derma care, LASIK
“University hospitals survive on
ancillary services such as rents
and parking lots”
“National University hospitals
generated $5Mil of profit from
running parking lots”
1
10. The medical fee system has driven arms race among hospitals, and
medical expense is concentrated among large hospitals
Big5 Hospitals Beds
Asan Medical Center 2,680
Severance Hospital 2,081
Samsung Medical Center 1,982
Seoul Nat’l Univ. Hospital 1,789
Seoul St. Mary Hospital 1,332
• AMC does ~10% of all the
cancer surgeries in Korea
• No. of cancer surgeries/yr
: AMC (18,508) VS MSKCC
(11,370) VS MD Anderson
(8,656)
2
11. Education programs and care services are uncovered and not
appreciated by patients, which results in lack of proper care
•Disease education and life style modification program are essential
to chronic diseases and lead to reduced medical bill in the long run
•In general, such services are not covered by NHIS
•Patients who are accustomed to cheap medical care do not
appreciate intangible services such as consultation and education
•As a result, hospitals tend to offer $10~20 for diabetes education
program
•~20% of newly-diagnosed diabetes patients get education program
3
12. Expected worsening balance of NHIS has made government
introduce various initiatives for health management service
Financials of NHIS Government policy for public health
• Foster personalized health support service
- Develop health counselling call centers and
health managers
• Launch smoke-quitting campaign
• Launch chronic condition prevention/mgmt
service
- Strengthen health counselling for
prevention/mgmt of chronic conditions
• Develop/introduce a checkup program for
teens
• Tried in vain to make a law about
wellness/disease management service
Expand
prevention/mgmt-
focused policy
(through public
hospitals and/or
public clinic
service)
Induce private
sector
engagement in
wellness/disease
management
service
• Run pilot for doctor-patient telemedicine & Try
to amend the current medical law
• Interested in introducing mobile health
technology
Introduce
telemedicine &
ICT technology
4
13. Faced with low profit/growth, Korean insurance industry has strong
needs to introduce health management program
Share of Health insurance premium by age group Trends of health insurance loss ratio
New
subscribers
in their
20s/30s
account for
~73%
Cumulative
share of
40s+
customer
reaches
~65%
Acquire
potential new
customers
Capture up &
cross-selling
Opportunity
• With a recent increase in 20s/30s subscription,
the need for an effective tool to appeal to customers
has arisen
- In ’14 YoY, 20s subscribers increased from 56% to 76%,
30s subscribers grew from 70% to 74%
• Need for health mgmt service catering to post-
retirement medical/care needs of 40s to 60s, a key
customer segment of insurers
- Retiree/pre-retiree pouplation to increase from 17M
in ’15 to 20M by ’20
- Major insurance needs of 50s/60s are long-term care
and medical expenses
• Profit has been eroded as return on
asset under management, insurers’
key profit source, decreased amid
prolonged low interest rates
• Also facing growing mortality loss
of health insurance, etc., loss
ratio improvement is imperative
- Risk mgmt is also important due to
pricing regulations
• Strong needs for claim prevention
exist via cost efficiency
improvement and customer health
mgmt
Preemptive
loss ratio
mgmt
4
14. ISSUE 1: For-Profitization
•Government
• Officially against for-profitization of medicine
• Keen on nurturing service industry (employment issue)
• Interested in medical tourism and export of Korean medical
system
• A Chinese, for-profit, aesthetic hospital is approved
• SNUH is running a hospital in Dubai
•Doctors: against for-profitization
•Hospitals
• Mixed but KHA is for
• Some feel the need to make up for the losses incurred by
below-the-cost medical fee by operating business
•Civic groups: against for-profitization (influence of the movie ‘Sicko’)
15. ISSUE 2: Telemedicine & Remote monitoring
• By law, only doctor-to-doctor telemedicine is allowed
• Limited utility in Korea
• Doctor consultation is cheap (1st
visit ~$13, Repeat visit ~$9)
• People are concentrated and access to care is excellent
•
• Government
• Tries to allow doctor-to-patient telemedicine
• Part of a plan to boost technology sector (& overall economy)
• Runs pilot programs for rural people & military
• Doctors
• Feels that telemedicine which will be dominated by ‘factories’ and large
hospitals will threaten the clinics
• Hospitals
• Mixed but KHA is for
• In line with the attitude towards for-profitization
• Civic groups: mixed
• Some regard it as start of ‘for-profitization’
• Less opposition than with ‘for-profitization’
16. ISSUE 3: Wellness/Disease management service
•Legal grey area. By law, ‘medical care’ could only be carried out
within medical institutions in principle’
•Government tried in vain to make a law about wellness/disease
management service (population health management)
•The effort faced opposition from
• Hospitals: non-medical institutions may come in
• Doctors and civic groups: start of for-profitization
• Concern regarding involvement of insurance companies due
to possibility of information leak, market control by large
corporations
•The law failed to pass even after insurance companies were dropped
(insurance companies not allowed to found or invest in entities for
wellness/disease management service)
17. Several specialty companies are running preliminary wellness
services
HealthonHealthonAIMMEDAIMMED
Greencross
healthcare
Greencross
healthcare365 Homecare365 Homecare
Part of OpenTide,
subsidiary of
Samsung SDS
Owner-
ship
Busi-
ness
Clients
Insurance/major companies/foreign companies
Subsidiary of
Greencross
pharma
Subsidiary of
Medipost (stem
cell company)
1999 년 10 월
JV of SKT and
Seoul Nat’l Univ.
Hospital (SNUH)
Preliminary Wellness Service
- Phone counselling, reservation/escort service
- Deliver health-related contents
- Referral service for US hospitals
Wellness
- App + Wearable
- SNUH-made
health contents
- (Reward-linked)
B2C, SK
NoomNoom
JV of SKT and
Seoul Nat’l Univ.
Hospital (SNUH)
Wellness+Disease
- App-based
- Obesity, DM, HT
B2C, NHIS…
Notas do Editor
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group
Our assessment of health-care quality focused on macro-level metrics (e.g., average life expectancy). In addition to these macro level metrics it is also recommended to go one level deeper and analyze micro-level quality metrics as they are equally important reflections of quality. (e.g., cancer survival rates).
We measured access to health care in several ways. The most basic question was: Who is eligible? Some governments grant access to all residents; others limit participation to specific groups (usually, citizens). However, we also considered resource availability: Were there enough physicians and nurses? How long did people have to wait for treatment?
To assess financing, we differentiated between systems that were largely paid for through taxes and those that were financed through insurance. However, we also examined the extent to which the systems were publicly financed and the extent to which participants were expected to help pay for the cost of their care.
Many of the issues we considered when we looked at providers also related to financing. We wanted to know, for example, whether most physicians were paid under fee-for-service arrangements or were salaried employees. We also wanted to know who owns most hospitals – the government, nonprofit organizations, or for-profit companies.
To assess the role of government, we considered a number of questions, including: To what extent was the government involved in provision? How centralized or decentralized were the system’s operations?
DRG – diagnosis-related group