This study aims to examine the quality of health care in Korea, focusing on health outcomes and the role of regions in improving health system performance. First of all, we updated the research framework of 「Evaluation of innovation performance of the Korean healthcare system (6th year)」 to examine the quality of healthcare care in Korea and monitor the quality of healthcare care and system performance using available data. Next, we reviewed the current status of the local healthcare system in Korea and issues related to the region's role and the operation of the local healthcare system.
Regarding the first topic, healthcare quality, and healthcare system performance monitoring, this study reviewed indicators related to cancer, dementia, acute care, rehabilitation, and dental diseases through consensus workshops. The main results of reviewing trends using selected indicators are as follows. First, amenable mortality decreased overall, but some indicators, such as colorectal cancer, have recently worsened. It seems to be related to the late detection of cancer. Next, the gradual decline in health-related quality of life for people with chronic diseases is related to the treatment-oriented nature of the Korean healthcare system. The Korean healthcare system should strengthen its role in helping patients manage diseases and promote health based on the community. The dementia management rate in the community has continuously improved. However, the ratio of patients with dementia to those with presumed dementia has continued to decrease, suggesting that more policy efforts are needed to prevent dementia patients who need management from being neglected. Regarding patient safety, the number of patient safety accident reports decreased in 2021. However, since the number of reported patient safety accidents in Korea is low, it is more likely that the number of reports will decrease rather than the decrease in safety accidents.
Regarding the second topic, the regional healthcare system, this study reviewed the current status of the local healthcare system in Korea through literature reviews and in-depth interviews with local healthcare officials. As a result of examining the role of the region in-laws, prevention, health promotion, and social service-related laws determine the responsibilities of the Si(city), Kun(county), and Ku(district) level. However, The central government, cities, and provinces determined medical facilities and human resources. Local governments in Australia, the Netherlands, Germany, and the United Kingdom generally have a responsibility in health promotion and prevention. As a result of examining the linkage between laws, the Framework Act on Health And Medical Services has no provisions related to laws other than the health and medical field, such as the Framework Act on Social Security while the Framework Act on Regional Public Health Act broadly linked to laws in the fields of health promotion, medical care, and social service. Although it may not be appropriate to interpret only the provisions of the law, the region can potentially play a role in providing integrated services covering health promotion, medical care, and social service. As a result of examining significant policies over the past ten years on how the region's role is recognized in health and social service policies, the terms 'community-centered' and 'region-based' were used in the early 2010s. However, in terms of governance of policy implementation, it is only recently that the role of city/province or city/gun/gu local governments has been emphasized. The role of the local healthcare system may become crucial because of the increasing burden of chronic diseases and infectious diseases. The in-depth interviews with stakeholders showed that the main problems of the local healthcare system included a lack of policies suitable for regions, lack of policy experience, fragmented policies, financial deterioration of local governments, lack of regional capacity, and limited cooperative governance.
The implications of this study are as follows. First, concerning healthcare quality and performance reporting, a national-level performance monitoring system should be established based on health outcomes and person-centeredness and transparently disclosed to the public based on accountability. The Korean government has focused on evaluating the structure or process of the medical institution unit. However, these results do not match the degree of improvement in health outcomes at the system level. Also, this keeps us from continuing to maintain a treatment-oriented healthcare system. Lastly, long-term consideration is needed to ensure that quality evaluation is conducted at the national level and community level rather than the quality evaluation centered on medical institutions in order to reform the healthcare system in Korea.
Next, regarding the role of regions in improving health system performance, we need to consider providing incentives to local governments that strive for the health of residents. Next, considering that local communities play an essential role in health promotion and prevention, support is needed to develop and implement projects suitable for current issues in the region. Finally, it is necessary to establish the plan for development of health and medical services and the regional healthcare plan through mutual communication between the central and local governments in order to improve health performance at the system level. Lastly, we should explore what role the region should play in improving the health and well-being of residents and what the role of the actors at each level of government should be in the long term.