Korea health demonstration project

This report evaluates a project to create a capability within the Government of Korea (GOK) to plan, conduct, and evaluate low-cost, multi-county, integrated health delivery projects. After outlining the project's setting, design, and implementation, the report focuses on the project's institution building and health care delivery impacts. Initial progress was considerable. The Korean Health Development Institute (KHDI) was created to implement health delivery systems in three counties, and a National Health Council was formed to coordinate participating public and private agencies. The KHDI's approach was to introduce a new cadre of multipurpose para-professionals and to improve the professional capabilities of an existing single-purpose cadre. The two cadres then worked through teams of village volunteers to increase community involvement in health care delivery. By 1978, considerable progress had been made in improving access to health care in the three project areas; the average cost per visit at the most peripheral health unit was $1.90. Concurrently, physicians' share of the market fell 40-50%. At the urging of physicians, health paraprofessionals were disallowed from providing services outside their legal scope of practice. Other significant events also occurred during 1978-80. The number of medical school graduates doubled and more graduates were assigned to rural areas, a comprehensive GOK health insurance program was launched, and per capita income in the three counties grew. As a result, health service utilization fell markedly and the cost per curative visit rose to $3.00. The authors notes several lessons, including: the riskiness of developing an extra-governmental agency such as the KHDI; the need to anticipate economic impacts of changes in health care policy; the need to perform incentives and contextual analysis of all potential project actors; and the difficulty in determining a project's impact on overall health status. A postscript addresses the long-term financial impact of the GOK's health insurance program. Extensive tables, charts, and graphs are contained in the text and in appendices; the latter also includes a 33-item bibliography (1975-81), a report on the current status of health care delivery in Korea, project-related public documents, and other information.