title: Do differences in profiling criteria bias performance measurements? Economic profiling of medical clinics under the Korea National Health Insurance program: an observational study using claims data.
abstract: BACKGROUND
  With a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician's relative resource use. This study explored the major factors that influence the economic performance rankings of medical clinics in the Korea National Health Insurance (NHI) program by assessing the consistency between cost-efficiency indices constructed using different profiling criteria.
  
  
  METHODS
  Data on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic.
  
  
  RESULTS
  The exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably.
  
  
  CONCLUSIONS
  A medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.
authors.affiliation: Health Insurance Review & Assessment Institute, Health Insurance Review & Assessment Service, Seoul, Republic of Korea. kanghj71@gmail.com
authors.forename: Hee-Chung
authors.initials: HC
authors.lastname: Kang
authors.forename: Jae-Seok
authors.initials: JS
authors.lastname: Hong
mesh_terms: D000554:Ambulatory Care Facilities / Q000145:classification* / Q000191:economics*; D015982:Bias; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D017598:Efficiency, Organizational / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000191:economics*; D007723:Korea; D008297:Male; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics* / Q000458:organization & administration