Mild Patients Seeking Tertiary Hospitals Directed to Local Clinics... Ministry of Health Launches 'Severe Care Enhancement Pilot Project'

Outpatient Visits at Tertiary Hospitals Increased by 23% Over the Past Decade
Concentrated Efforts on Severe Disease Treatment and Research Are Dispersed
Mild Patients Encouraged to Receive Treatment at Local Medical Institutions

The Ministry of Health and Welfare will conduct a pilot project to have tertiary general hospitals focus on severe and high-complexity treatments, while guiding mild patients to receive care at local medical institutions. This initiative responds to concerns that mild outpatient cases are concentrated in large hospitals, dispersing the capabilities of tertiary general hospitals that should be focusing on treating and researching severe diseases. Ultimately, the plan aims to streamline the medical care system and improve the quality of medical services by having tertiary general hospitals primarily treat severe inpatients and mild patients receive treatment at primary and secondary medical institutions in their residential areas.

On the 25th, the Ministry of Health and Welfare announced the introduction of the 'Severe Care System Strengthening Pilot Project,' which centers on reducing outpatient care at tertiary general hospitals, and selected three institutions?Samsung Seoul Hospital, Ulsan University Hospital, and Inha University Hospital?as pilot project sites.

At the '2nd Health Insurance Policy Deliberation Committee' held that day, the Ministry discussed the implementation plan for the Severe Care System Strengthening Pilot Project. This project aims to establish a cooperative system where tertiary general hospitals focus on treating and researching severe diseases, while patients with lower severity are redirected to local medical institutions near their residence. It is a measure to improve the situation where mild outpatients flock to tertiary general hospitals, preventing severe patients who need treatment at these hospitals from receiving adequate care.

According to the Ministry, the number of patients receiving outpatient care at tertiary general hospitals has been increasing. From 2012 to 2022, over the past decade, the number of outpatient visits to tertiary general hospitals increased by 23%. The proportion of outpatient care costs within total medical expenses is also high at 37%. A Ministry official stated, "Tertiary general hospitals should primarily focus on severe inpatient care, but the continuous increase in outpatient care is problematic," adding, "There is a need to curb the rising mild outpatient care."

The government has attempted to reduce the proportion of outpatient care at tertiary general hospitals by excluding mild disease outpatient visits from the benefits of the out-of-pocket maximum payment system, but the effect has been minimal. Through this pilot project, the Ministry will shift from penalizing patients to providing incentives to tertiary general hospitals. Participating hospitals will set annual targets for outpatient reduction and strengthening severe care, and will receive rewards based on performance results after the project. The hospitals must reduce outpatient visit days by at least 15% over three years, with a minimum 5% reduction each year. Losses in medical fees due to reduced outpatient visits will be compensated through this performance evaluation. A Ministry official said, "The goal is to encourage the use of funds saved from reduced outpatient care to strengthen severe care."

The Ministry also expects the pilot project to promote the mutual growth of tertiary general hospitals and local medical institutions. Previously, lack of coordination among primary to tertiary medical institutions led to competition over patients. The three selected tertiary general hospitals will refer patients to cooperating medical institutions near their residence based on severity and establish cooperative systems with medical institutions nationwide or regionally. Additionally, to ensure patients can receive appropriate care with confidence at local medical institutions, information must be shared with these institutions. Use of cooperative care, patient health outcomes, and patient experience when using local medical institutions will also be included in the performance evaluation criteria for reward payments.

The Ministry anticipates that through this pilot project, tertiary general hospitals will provide timely care to severe patients, and local cooperating medical institutions will enhance their capabilities through accumulated experience in collaborative care of referred patients. From the patients' perspective, general medical needs will be met within their residential area, and receiving care at the appropriate level is expected to reduce future medical expenses.

This content was produced with the assistance of AI translation services.