Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance

조산원(助産院)의 분만간호서비스에 대한 건강보험수가 산출방법과 적용방안

  • Kim, Jin-Hyun (College of Nursing, Seoul National University) ;
  • Jung, Yoo-Mi (College of Nursing, Seoul National University)
  • Published : 2009.08.28

Abstract

Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

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