Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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The Impact of Diagnostic Imaging Fee Changes to Medical Provider Behavior: Focused on the Number of Exams of Computed Tomograph

영상진단 수가 변화가 의료공급자 진료행태에 미치는 영향: 전산화단층영상진단 검사건수를 중심으로

  • Cho, Su-Jin (Health Insurance Review & Assessment Institute) ;
  • Kim, Donghwan (Health Insurance Review & Assessment Institute) ;
  • Yun, Eun-Ji (Health Insurance Review & Assessment Institute)
  • 조수진 (건강보험심사평가원 심사평가연구소) ;
  • 김동환 (건강보험심사평가원 심사평가연구소) ;
  • 윤은지 (건강보험심사평가원 심사평가연구소)
  • Received : 2018.01.12
  • Accepted : 2018.03.15
  • Published : 2018.06.30
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Abstract

Background: Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes. Methods: The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied. Results: The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals. Conclusion: Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

Keywords

References

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