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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

Abstract

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.

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