Korea to reward hospitals more for treating critically ill patients under new ICU workload index

South Korea will introduce an "ICU workload index" to give higher performance ratings to tertiary hospitals that actively treat critically ill and pediatric intensive care patients, and will distribute 80 billion won ($54 million) in differentiated rewards to strengthen their capacity for severe and definitive care.

The Ministry of Health and Welfare announced Tuesday that it will adopt the ICU workload index as a second-half performance indicator under the "Tertiary Hospital Structural Transformation Support Project," aimed at more fairly evaluating and rewarding ICU operations.

The existing ICU compensation system has centered on structural indicators such as the presence of dedicated specialists and nursing ratings and facility standards. However, even when bed capacity and staffing levels are identical, the actual workload on medical staff and resource consumption can vary significantly depending on the proportion of severely or highly complex patients — a gap the previous system failed to adequately reflect in compensation.

Although general wards at tertiary hospitals have been shrinking while ICU capacity has expanded, a shortage of intensive care beds has consistently been cited as a leading reason for turning away emergency patients, keeping pressure on the system to improve.

The government had agreed in January, following discussions at the second session of the National Health Insurance Policy Deliberation Committee, to introduce new performance indicators capable of measuring ICU capacity.

The ICU workload index is calculated by taking the total volume of patients admitted to intensive care units, applying weighted values for the proportion of critically ill patients and pediatric patients under 18, and dividing the result by the annual number of ICU beds.

Hospitals that more actively treat critically ill patients and pediatric intensive care cases — which require comparatively greater resources — will receive higher ratings under the new index.

The ministry said it plans to continue refining existing performance indicators and developing new ones based on expert input, with the goal of significantly strengthening overall critical care capacity.

The ministry will disburse 80 billion won in performance rewards reflecting the ICU workload index, drawn from the roughly 800 billion won allocated for the second year of the Tertiary Hospital Structural Transformation Support Project.

Of the total, 30 percent — 24 billion won — will be distributed in proportion to each hospital's ICU workload index score, while the remaining 70 percent — 56 billion won — will be paid out according to weighted performance grades assigned by workload index range.

Performance grades are divided into four tiers from A to D based on the workload index, with the system designed to ensure meaningful rewards for facilities where medical staff carry the heaviest burdens.

The rewards will apply to tertiary hospitals based on an evaluation of their third- and fourth-quarter performance this year, with actual payments disbursed in June next year. Because performance will be calculated using each hospital's national health insurance claims data, the additional burden of submitting separate documentation will be kept to a minimum.

Lee Jung-gyu, the ministry's director-general for public health policy, said the introduction of the ICU workload index "marks a shift toward value-based compensation that provides appropriate rewards for the efforts of medical staff and hospitals saving the most critically ill lives." He added that the ministry would "continue to raise the weight of compensation tied to outcomes in severe and emergency care, and support tertiary hospitals in focusing on their core role within the healthcare delivery system."