Changes in Providers' Behavior after the Reviewer Unification of Auto Insurance Medical Benefit Claims

자동차보험 진료비심사 일원화 이후 의료기관 진료행태 변화

  • Kim, Jae Sun (Department of Human Resource Administration, Health Insurance Review and Assessment Service) ;
  • Suh, Won Sik (Department of Healthcare Management, Gachon University College of Social Science)
  • 김재선 (건강보험심사평가원 인재개발부) ;
  • 서원식 (가천대학교 사회과학대학 헬스케어경영학과)
  • Received : 2016.12.05
  • Accepted : 2017.01.16
  • Published : 2017.03.31


Background: This study aims to analyze the behavioral changes of healthcare providers and influencing factors after the reviewer unification of auto insurance medical benefit claims by an independent review agency. Methods: The comparison data were collected from the second half of 2013 and the same period of 2014. The key indicators are the number of admission days, the number of outpatient visits, inpatient ratio, inpatient medical expenses, and outpatient medical expenses. Results: Four indicators (number of admission days, number of outpatient visits, inpatient ratio, and outpatient medical expenses) showed statistically significant drops, while one indicator (inpatient medical expenses) showed no significant change. Conclusion: The reviewer unification of auto insurance medical benefit claims by an independent review agency showed significant reduction in cost and patient days.


  1. Chung SK, Park JH, Jeon JS, Chung YK, Kim YT, Park KY, et al. The preliminary study on improving the medical care system of auto insurance patient. Seoul: The Catholic University of Korea-Industry Academic Corporation Foundation; 2011.
  2. Korea Insurance Development Institute. Optimization of medical expenditures in auto insurance: CEO report. Seoul: Korea Insurance Development Institut; 2006.
  3. General Insurance Association of Korea. Progress report on entrusting medical claims review process to independent agency. Seoul: General Insurance Association of Korea; 2008.
  4. Anti-Corruption and Civil Rights Commission. Improving healthcare reimbursement system. Sejong: Anti-Corruption and Civil Rights Commission; 2009.
  5. Cho GS. A study on reasonable program of automobile insurance medical fee system. Law Rev 2010;51(2):1-16.
  6. Lee DR. Improvement measures for the shortfalls in the medical fee system of automobile insurance [master's thesis]. Seoul: Yonsei University; 2002.
  7. Yoon IS. Propriety examination of medical treatment pay expense examination unification legislation [master's thesis]. Seoul: Yonsei University; 2006.
  8. Ahn BJ. Issues on auto insurance medical claims system and role of hospitals in society. Health Policy Forum 2006;4(1):85-95.
  9. Yoo HS, Park TS. An analysis of automobile insurance and health insurance patients' uses of the medical services. J Orient Med Prev 2007;11(2):175-188.
  10. Kim JH, Yoo WK, Kim TY. A study on innovations in the medical rehabilitation fee schedule of the industrial accident compensation insurance. Sejong: Ministry of Employment and Labor; 2008.
  11. Kim SM, Yoo SY, Kim KH, Lee JK, Shim YJ. Improving medical claims system of auto insurance. Health Policy Forum 2006;4(1):65-88.
  12. Evans RG. Supplier-induced demand: some empirical evidence and implications. In: Perlman M; International Economic Association, editors. The economics of health and medical care. London: Macmillan; 1974. pp.162-173.
  13. Yang BM. Health economics. Seoul: Nanam Publishing; 2006.
  14. Chung DM. Study on the improvement of medical care system of automobile insurance [master's thesis]. Seoul: Yonsei University; 2003.
  15. Kwon EJ. A study in the effect of hospital competition on the behavior of healthcare suppliers [master's thesis]. Seoul: Hanyang University; 2010.
  16. Eisenberg JM. Physician utilization: the state of research about physicians' practice patterns. Med Care 2002;40(11):1016-1035. DOI: https//