Patient assessment of primary care under the Designated Practice Scheme for Medical Aid beneficiaries, using the Korean Primary Care Assessment Tool (K-PCAT): a district of Seoul, South Korea

Article information

J Korean Med Assoc. 2012;55(2):187-197

Publication date (electronic) : 2012 February 08

doi : https://doi.org/10.5124/jkma.2012.55.2.187

Jae-Ho Lee, MD ¹, Yong-Jun Choi, MD ², Ji-Sook Choi, PhD ³, Sera Kim, PhD ³

¹Department of Family Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.

²Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea.

³Research Department, Health Insurance Review and Assessment Service, Seoul, Korea.

Corresponding author: Jae-Ho Lee, jaeholee@catholic.ac.kr

Received 2011 December 28; Accepted 2012 January 10.

Abstract

To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (≥3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.

Keywords: Primary health care; Quality assurance; Medical aid; Republic of Korea

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Table 1

General and socio-demographic characteristics of study sample - participants in the DPS in a district of Seoul

Chi-square test.

DPS, Designated Practice Scheme; NBLS, National Basic Livelihood Security; PCP, primary care practice.

^a)PCPs include general practice (50), family medicine (4), internal medicine (49), and pediatrics (0).

^b)Others include speciality practices displaying anesthesia and pain (9), urology (2), ophthalmology (2), ear, nose, and throat (3), general surgery (12), rehabilitation medicine (5), psychiatry (7), and orthopedic surgery (11)

Table 2

Patient assessment of primary care using the K-PCAT under the DPS

Student t-test or ANOVA with multiple comparisons by least significant difference (^†,^‡P<0.05).

K-PCAT, Korean Primary Care Assessment Tool; DPS, Designated Practice Scheme; SD, standard deviation; NBLS, National Basic Livelihood Security; PCP, primary care practice.

^a)PCPs include general practice (50), family medicine (4), internal medicine (49), and pediatrics (0).

Table 3

Patient assessment of the first contact domain in primary care using the K-PCAT under the DPS

Student t-test or ANOVA with multiple comparisons by least significant difference (^†,^‡P<0.05).

K-PCAT, Korean Primary Care Assessment Tool; DPS, Designated Practice Scheme; SD, standard deviation; FCU, first contact utilization; FA, facility accessibility; CA, cost appropriateness; DA, demographic accessibility; BHC, basic health care; NBLS, National Basic Livelihood Security; PCP, primary care practices.

^a)PCPs inclde general practice (50), family medicine (4), internal medicine (49), and pediatrics (0).

Table 4

Factors associated with primary care quality (total average score of the K-PCAT) assessed by participants in the Designated Practice Scheme

Multiple logistic regression analysis.

Response variable (total average score of primary care) categorized dichotomously as 'good' (≥58.1) and 'poor' (<58.1). Adjusted by age, sex, education year, title as Medical Aid beneficiary, type of practice (in model 1), and duration since the first visit (in model 2). Because two important explanatory variables are closely associated (P=0.001, degree of freedom=1, chi-square test), two models are presented.

K-PCAT, Korean Primary Care Assessment Tool; CI, confidence interval; NBLS, National Basic Livelihood Security.