Healthcare delivery reform for reducing health inequality

Abstract

Care Coordination refers to care delivery system or service programs which involved multi-providers work in coordinated manner not only to improve care quality and patients satisfaction but also to use resources efficiently. The objectives of this study are to suggest a new primary care oriented coordination system based on the previous research evidence and data analyses. For the purpose, the study analyzed patients' perception and patients care utilization pattern using interview survey and 2004～2008 insurance claim data. To conclude, care coordination is limited and patient satisfaction is higher in the group which have the family doctor. We learn from OECD countries and study several care coordination model or schemes such as chronic care model, medical home model, and polyclinic. Main characteristics of new system the study proposed, are as following. First, new scheme is based on the idea of patient centeredness. Patient-centeredness means to put priority on patients' perception, belief, value, and cultural background in making a decision of care service. Second, patients participated in the scheme have own a family doctor as a main service provider and care coordinator. Third, the scheme includes chronic disease management program as a part of care coordination. To efficient approaches, patient classification is needed based on case-mix. Fourth, the intergration of organizations would provide better seamless services because care fragmentation usually occurs in interface between the care organizations. Fifth, information technologies act on primary infrastructure, and shared patient information would not only enhance the communication efficiency among service providers but also the effects of care coordination. Finally, carefully organized reimbursement plans for providers would increase the effectiveness of new scheme. For payments, a variety of method can be introduced including mixed payment with incentives. Paralleling with providers, recipient's incentive system also improve the participation rate and patients corporations. Introducing a new system may be hampered by the obstacles from several stakeholders, especially providers' organization. Low level of care coordination would be a starting point, such as a family doctor for the chronic patients. Care coordination is getting a main policy issue for the health system performance improvement. First priority is the policy resolution for achieving the goals.