Should Korea introduce its version of the ACO (Accountable Care Organization) system? Provided the answer is “yes,” is the nation ready enough to do so?
Pros and cons were rife over these questions at a workshop, organized by the think tank of the conservative opposition Bareunmirade Party, at the National Assembly on Jan. 17.
At the symposium held under the theme of “The Third Way of Welfare in Korea,” the organizer, Bareunmirae Institute, said that the paradigm of the social security system, such as health insurance, should change to a Korean ACO system, which focuses on providing healthcare service through a network of local medical institutions.
In 2010, the U.S. formalized the ACO system under the “Patient Protection and Affordable Care Act (PPACA)” to provide integrated healthcare to Medicare members and reduce unnecessary healthcare services as well as improve the quality of the service.
ACO system -- which offers incentives when the goal is met by reducing medical expenses and improving healthcare quality in the integrated healthcare delivery system -- should adjust itself to the Korean culture, a researcher of the institute said.
The opposition party used to emphasize that the “Moon Jae-in care,” or Mooncare, should strengthen health insurance in particular, by working out a policy to ease the financial burden and the problem of patients concentrating in large hospitals.
Although Mooncare aims to strengthen healthcare guarantee, the Korean health insurance system is still struggling with financial depletion, and patients tend to visit only large hospitals. ACO is a future-oriented system that offers incentives to organizations that help the Korean people maintain healthy lives, the institute said.
"We expect the ACO system can help establish a system for active healthcare by shifting the medical paradigm from treatment-oriented one to that focusing on proactive prevention," Hong Gyeong-jun, director of the Bareunmirae Institute, said.
Professor Chun Ki-hong of the Ajou University School of Medicine also said, "The introduction of the health insurance ACO system will not only improve the overall level of public health but also control the increase of the health insurance expenditure by shifting it to a value-based payment system.”
Chun Ki-hong, a professor of the Ajou University School of Medicine, made a presentation on the proposal for introducing the health insurance ACO system. "Under the current quantitative care payment system, it seems difficult to control the increasing rate of insurance claims to that premium receipts," Chun said. "There should be a value-based system where medical workers consider the citizens' health and expenses before providing the treatments."
To introduce the ACO system, however, current medical law should be revised in ways to ban the allocation of non-profit foundations' savings, arranging to patients to other medical service providers, and dual openings of medical institutions, he noted.
Chun proposed to establish an institutional foundation through enacting the temporarily entitled “Special Act for Health Management of Population Group,” implement a pilot project based on the two types of networks – one composed of tertiary hospitals and the other comprised of individual clinics.
Medical community split over ACO
Healthcare professionals presented various opinions on the introduction of the ACO system. Kim Yoon, a professor at Seoul National University College of Medicine, said that the introduction of the ACO system is required to prevent the current medical system from collapsing.
"South Korea's current medical paradigm to enhance guarantee has already reached its limit," Professor Kim said. "The existing systems are not sustainable."
As the government presented short-term solutions to improve the medical delivery system, large hospitals have been trying to reduce the number of patients with light symptoms. A system that allows patients to choose healthcare providers rationally is necessary, he added.
In particular, he stressed that the government should support the cost of constructing the initial infrastructure for the introduction of the ACO system.
Park Eun-cheol, a professor of the Yonsei University College of Medicine, also agreed to accept ACO in that the insurance system needs to change. On the other hand, he expressed concerns that the current unified health insurance system could be an obstacle to medical development.
"A unified form of health insurance is difficult to satisfy people with various needs, and we need a new wage structure because health insurance has changed a lot since the introduction in 1977," Professor Park said. "The health system seems to be disrupting development in the medical field, so we need the ACO system to overcome this situation."
There were also views opposing the introduction of ACO. Sung Jong-ho, policy director of the Korean Medical Association, pointed out that the Korean ACO system has positive aspects such as shifting the medical paradigm not only to the payment system but also to the prevention of diseases such as the medical delivery system. However, the introduction of the system is premature.
There are many objections in the medical community because the ACO system is considered as a gross contract system. It is questionable whether the activation of the ACO system within the original designation system is possible, Sung said.
Lee Dong-woo, a deputy director at the Department of Health Insurance in the Ministry of Health and Welfare, said, "There is a need to discuss the ACO system, but we should consider the introduction of it with more caution."
"To introduce the ACO system, we should modify the current medical system to prevent doctors from regarding as tools of profit-making,” Lee said. "Also, we need to discuss to find ways of compensating and benefitting medical service providers faced with unlimited competition. The government should also rack its brain to come up with a better payment system.”
<© Korea Biomedical Review, All rights reserved.>