• Title, Summary, Keyword: 포괄 수가제

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Changes in the Hosptal Length of Stay and Medical Cost between before and after the Applications of the DRG payment system using Health Insurance Big Data (건강보험 빅 데이터를 활용한 종합병원에서의 포괄수가제 적용 전·후 재원일수와 진료비의 변화)

  • Jeong, Su-Jin;Choi, Seong-Woo
    • The Journal of the Korea institute of electronic communication sciences
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    • v.12 no.2
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    • pp.401-410
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    • 2017
  • This study aimed to identify appropriateness and efficiency in the DRG payment system by analysing the hospital length of stay and changes in fees before and after the application of DRG payment system. The subjects of the study were a total of 398 patients consisting of 204 for the fee for service system and 194 for the DRG payment system. They received surgery in the Obstetrics and Gynecology (OBGY) department of a general hospital in G metropolitan city between January and December 2013. The mean hospital length of stay was significantly decreased after application of the DRG payment system(p=0.013). Total fees, insurance charges, and deductions increased significantly(p<0.001), and non-payment charges and total deductions decreased significantly(p<0.001). Application of the DRG payment system reduced length of stay, non-payment charges and total patient's cost sharing and increased out-of-pocket, insurance charges, and total fees.

Constitutional Limits of the Medical Fee Payment System and the Unconstitutionality of Fixed Payment System (진료수가제도의 헌법적 한계와 정액수가제의 위헌성 -헌법재판소 2020. 4. 23. 선고 2017헌마103 결정을 중심으로-)

  • Hyun, Doo-youn
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.69-105
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    • 2020
  • In the health care system, medical fee payment is a very important and basic factor. The National Health Insurance Act adopted a contract system, and the content of the contract is to be determined the unit price per relative value scale. Accordingly, in the National Health Insurance system, the costs of health care benefits are adjusted each year according to inflation or changes in economic conditions. On the other hand, in the Medical Care Assistance system, the Medical Care Assistance Act does not prescribe the method of determining the medical payment, and all matters are delegated to the Minister of Health and Welfare. Accordingly, the Minister has adopted a fixed-payment system for hemodialysis treatment since 2001. A constitutional petition was filed in 2017 against this fixed-payment system, and the Constitutional Court rejected the petition in 2020. In this study, we examine the meaning and content of the medical fee payment system, focusing on the above constitutional petition case, and present three principles as constitutional limits on the system. The first of its principles is the principle of legality, the second is the principle of prohibition of comprehensive delegation, and the third is the principle of proportionality. From that point of view, There are many unconstitutional elements in the fixed-payment system on hemodialysis.

Development of the DRG Fee Adjustment Mechanism Reflecting Nurse Staffing Grades (간호관리료 차등제를 반영한 DRG수가 조정기전 개발)

  • Kim, Yunmi;Kim, Se Young;Kim, Jiyun
    • Journal of Korean Clinical Nursing Research
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    • v.19 no.3
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    • pp.321-332
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    • 2013
  • Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

Development of a Recording System for Home Health Care for Postpartum Women adn Their Newborns (병원 포괄 수가제 도입에 대비한 산욕부 및 신생아 가정간호 기록지 개발)

  • Kim, Hea-Sook
    • Korean Journal of Women Health Nursing
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    • v.2 no.1
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    • pp.25-39
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    • 1996
  • The Korean government has a new system for charging patient care for patients in hospital, on hold for the present(9 / 1995) but to start implementation in certain areas of patient care next year. From the latter half of next year the Ministry of Health and Welfare would like to start demonstration projects for hospitals who want to start using DRGs for frequently seen medical diagnosis and for patients with a course that is predictable and for whom non-insurance costs are minimal : such as the patient who has a delivery, cesarean deliveries, cataract surgery, tonsillectomy or an appendectomy, and apply the DRG system of payment for hospital care for these patients. The purpose of this study was to establish a recording system to give effective home health care to postpartum women and their newborns. Recently the government announced a DRG system to apply to postpartum women for pilot purposes starting next year. This gives impetus to the need to develop home care records that will allow for systematic recording and provide continuity and consistency in care across all health professionals and with in-depth communication between the professions to assure high quality care. There has been a rise in medical costs and a shortage of patient bed space in hospitals, particularly since the introduction of national medical insurance. The study focused on developing client selection criteria, a primary assessment tool, progress notes and nursing diagnoses applicable to postpartum and newborn clients. Selection criteria for home health care, assessment tool content, nurses progress notes and diagnoses were developed through a review of the literature, advice from professionals who are expert in home health care and actual practice in the use of recording tools through workshops. The recommendations based on the research results are as follows : 1) Replication and application of these tools is needed to test the validity of the tools 2) In order to have systematic nursing records standardization of records has to be done after nurses have had experience using them. 3) Reliability and validity of the tools has to be established through applicability to actual care situation.

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The Growth of the Korean Welfare State and its implications for redistribution: Who has been excluded? (한국 복지국가 성장의 재분배적 함의: 누가 복지국가로부터 소외됐는가?)

  • Nahm, Jaewook
    • 한국사회정책
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    • v.25 no.4
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    • pp.3-38
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    • 2018
  • This study aims to analyse the redistributive impact of the welfare state growth in Korea after 2000s and establish whether there are people excluded from the benefits of the growth. The growth of the Korean welfare state has been achieved by universalizing welfare benefits under the social insurance-centered institutions which are the legacies of the productivist/developmental welfare regime. When it comes to redistribution impacts, the welfare state growth improved inequality among old age populations to a certain degree due to the introduction of the Basic Pension. On the other hand, welfare benefits for the working poor population has hardly been improved in spite of the growing welfare state. It can be said, therefore, that low-income working-age populations have been excluded from the growth of Korean welfare state. These groups are mostly in middle-old age, unemployed or precariously employed and half of them were female householders. The exclusion of these groups from the Korean welfare state shows that the growth of the Korean welfare state was unbalanced. To include the excluded into the Korean welfare state, it is necessary to increase non-insurance social provisions, extend the range of application of the social insurances, integrate income protection, employment service, and vocational training for the working poor, and combine universal and targeted welfare benefits.

Research on Efficient Measures for National Crisis Management System (국가위기관리체제의 효율성 제고 방안 연구)

  • Lee, Hong-Kee
    • Korean Security Journal
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    • no.36
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    • pp.493-523
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    • 2013
  • The purpose of this research is to deduce the frailties of the operating condition of Korea's national crisis management system through a comprehensive perspective analysis. It is then to present efficient measures through the enhancement of these infirmities. For this, after examining the fundamental theory, we presented a development direction based on the current status of the 6 key systems composing the national crisis management system. We also included items regarding each of the policy proposal in our conclusion. The fundamental theory of Korea's national crisis management system has been integrated based on a comprehensive security concept. However, the system development which drives the integrated structure still remains solely as a legal and structural category. Thus, operating, informing-oriented, supporting management, and rearing professional manpower systems have yet to be cultivated with efficiency. In conclusion, this research is to present a development direction from a conceptual dimension and to analyze the current status of the 6 key systems which are law, organization, operation, information-oriented, support management, training, and education. Finally, this research highlights the policy measures to fully maximize system efficiency.

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The Honam Region제s Evolutions in the 1990s: Convergence or Divergence\ulcorner (1990년대 호남지역경제의 전개과정: 지역경제의 수렴 또는 확산\ulcorner)

  • 정준호
    • Journal of the Economic Geographical Society of Korea
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    • v.4 no.2
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    • pp.57-77
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    • 2001
  • The Honam region has been recognized as one of the most lagging regions in Korea. Drawing upon some decompositions oi Gross Regional Domestic Product(GRDP) per head and labor productivity, the overall trend of inequalities in Korea has been revealed and the trajectory of the Honam region's economic change has been identified by examining how the region's economic performance changed relative to that of Korea in the 1990s. There are some findings. First of all, Korea is characterized by strong divergence in the development of its region economies, in terms o\ulcorner per capita GRDP, which relies upon productivity differentials rather than differences in employment rates. Second, the Honam region has displayed poor economic performances in terms of GRDP per head except for Jeonnam. Third, the dramatic fall in cumulative population growth relative to the national average has been an important factor in the Jeonnam's overwhelming economic performance measured by per capita GRDP. Fourth, the decline in the relative productivity of the Honam region is mostly explained by falling relative regional productivity growth in construction, transport and manufacturing, although it should be noted that the latter sector has made positive contribution to raising relative regional productivity of Jeonnam. Fifth, overall the shift in employment to service sector, especially to social, personal, public, health, education, other services other than distribution, hotels, catering has tended to support relative regional productivities, along with the positive contribution being made oi agriculture, forestry and fishing to relative regional productivity growth in the Honam region.

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A Study on Perception and Attitudes of Examinees of Health Screening Center towards Health Examination (종합건강진단 수진자들의 건강진단에 대한 인식 및 태도에 관한 연구)

  • Bae, Seong-Wook;Lee, Kyeong-Soo;Kang, Pock-Soo
    • Yeungnam University Journal of Medicine
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    • v.13 no.1
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    • pp.59-77
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    • 1996
  • A survey was conducted to study perception and attitudes of examinees of health screening center towards items, cost and procedures of health examination and degree of satisfaction with health examination, from March 2 to May 31, 1995. The study population was 468 examinees received health examination at Health Screening & Diagnosis Center of Yeungnam University Hospital. A questionnaire method was used to collect data. The followings are summaries of findings : Examinees were predominantly male(77.4%); had college education(68.6%), and held white-collar workers(57.8%). Statistical significance of association between frequency of periodic health examination and other variables were tested by chi-square test. Examinees who have higher degree of concern regarding health and those who practice more exercise for health maintenance received health examination more frequently. The majority expressed that health examination is very beneficial and effective in terms of prevention and early detection of diseases. Also the majority revealed that they are satisfied with health examination. The majority expressed that procedures and time spent for health examination are adequate; interval of health examination is one year; and additional examination items are cerebral examination, neurological examination and gastrofibercope. The majority revealed that they want more information about chronic degenerative diseases and health maintenance and promotion. In conclusion, the study revealed that examinees seemed to have more positive perceptions and attitudes towards health examination.

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