Journal of Society of Preventive Korean Medicine (대한예방한의학회지)

Society of Preventive Korean Medicine (대한예방한의학회)
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Survey on practice behavior and model acceptance of traditional Korean medicine(TKM) doctors in order to develop health insurance payment model related with TKM clinical practice guidelines(CPGs).

한의임상진료지침 연계 건강보험 지불모형 개발을 위한 한의사 진료행태 및 모형 수용도 조사

  • Kim, Dongsu (Policy & Standards Planning Team, KM Standards Centers, Korea Institute of Oriental Medicine) ;
  • Lim, Byungmook (Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University) ;
  • Han, Dongwoon (Department of Preventive Medicine, College of Medicine, Hanyang University) ;
  • Park, Ji-eun (Policy & Standards Planning Team, KM Standards Centers, Korea Institute of Oriental Medicine) ;
  • Jung, Hyoung-Sun (Department of Health Administration, College of Health Sciences, Yonsei University)
  • 김동수 (한국한의학연구원 정책표준기획팀) ;
  • 임병묵 (한국한의학연구원 정책표준기획팀) ;
  • 한동운 (한양대학교 의과대학 예방의학교실) ;
  • 박지은 (한국한의학연구원 정책표준기획팀) ;
  • 정형선 (연세대학교 보건과학대학 보건행정학과)
  • Received : 2017.10.18
  • Accepted : 2017.11.25
  • Published : 2017.12.31
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Abstract

Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs). Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model. Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients. Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.

Keywords

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