Healthcare policy and healthcare utilization behavior to improve hospital infection control after the Middle East respiratory syndrome outbreak
Healthcare policy and healthcare utilization behavior to improve hospital infection control after the Middle East respiratory syndrome outbreak
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DOI：
10.5124/jkma.2015.58.7.598
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发表时间：
2015-07-01
影响因子：
0.3
通讯作者：
Kim, Yoon
中科院分区：
文献类型：
--
作者：
Kim, Yoon
2015 年 5 月韩国爆发的中东呼吸综合征冠状病毒 (MERS-CoV) 感染表明，韩国医疗系统和医院极易受到医院传播感染的影响。由于韩国医疗保健系统的独特特征，包括1）感染控制能力有限的医院，2）由于护理人员短缺而严重依赖私人护理人员，3）急诊室过度拥挤，以及4）与医疗保健相关的患者行为（例如医院购物），MERS-CoV感染在短时间内在韩国广泛传播。为了防止未来爆发类似中东呼吸综合征冠状病毒的新发传染病，韩国医疗保健系统应该进行改革，与医疗保健相关的患者行为也必须改变。为了提高医院感染控制的绩效，国民健康保险服务应支付更多的医院感染控制服务费用，并在医疗必要时覆盖私人病房，包括传染病患者。为降低私人护理相关的医院感染风险，应增加护士配备水平，医院应全面负责住院护理工作。为了减少医院购物，国民健康保险服务应引入差别化收费表，当初级保健提供者护理普通疾病患者和三级护理提供者护理重症患者时，支付更多费用。为了激励患者适当使用医疗保健，应将较低的患者自付费用与差别化的医疗服务提供者收费表相结合。
The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule.