DOI QR코드

DOI QR Code

History of the National Health Insurance Cost for Radiological Examinations and Value of the Radiological Report Fee

영상의학과 보험수가 역사와 판독료의 가치

  • Choong Wook Lee (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 이충욱 (울산대학교 의과대학 서울아산병원 영상의학과)
  • Received : 2020.06.16
  • Accepted : 2020.09.08
  • Published : 2020.09.01

Abstract

Advancements of medical care with the use of new medical technologies have been promoting public health, but they can also place a financial burden on individuals and the country. Since the introduction of the health insurance system in 1977, the South Korean government has been attempting to control medical expenses. Radiological examinations have been a major target for cost reduction. Meanwhile, the radiological report fee has been combined with the technical fee for a long time; hence, its value has not been independently evaluated, and was also decreased proportionally with examination cost reduction. However, in the revised medical fee estimation system for MRI, the report fee has begun to be calculated separately from the technical fee, significantly contributing to the evaluation of the radiologists' work value. In conclusion, radiologists need to know and actively participate in the process of determining the insurance cost of radiological examinations and reports to get a proper value of their professionalism.

새로운 의료기술 개발을 통한 의료의 발달은 국민건강증진 효과를 가져왔지만, 의료비 상승의 원인이 되어 개인과 국가의 재정부담의 원인이 되기도 한다. 재정부담 완화를 위해 1977년 의료보험제도 도입 이래 다양한 기전을 통해 의료비 통제를 시도하고 있으며 영상검사도 주요 삭감 대상이 되어왔다. 한편 판독료는 오랜 기간 동안 영상검사 촬영료와 묶여서 산정되어, 영상의학과 전문성에 대한 가치를 독립적으로 평가받지 못하고 단지 영상검사의 일부분으로 평가되어 영상검사 수가 삭감 시 판독료의 가치도 함께 낮아지는 문제점이 있었다. 다만, 새로운 건강보험 보장성 강화 대책을 통해 개편된 MRI 수가 체계에서 판독료가 촬영료와 완전히 분리되어 산정되기 시작한 것은, 영상의학과 의사 업무의 고유 가치를 평가하는데 큰 기여를 할 수 있다. 결론적으로, 영상의학과 의사가 영상검사 수가 및 판독료 산정 과정에 대해서 명확히 알고 적극적으로 참여해야 하며, 이러한 노력을 통해 영상의학과의 전문성에 대한 적절한 가치를 인정받을 수 있을 것이다.

Keywords

References

  1. National Federation of Medical Insurance. History of Medical Insurance. Available at. http://www.hira.or.kr/sViewer/index.do?ebookSn=350. Published 1997. Accessed Jun 1, 2020
  2. Ministry of Health and Social Affairs. Notice No. 17. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028090327#98. Published 1977. Accessed Jun 1, 2020
  3. Ministry of Health and Social Affairs. Notice No. 16. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028090327#22. Published 1977. Accessed Jun 1, 2020
  4. Ministry of Health and Social Affairs. Notice No. 55. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028103280#19. Published 1978. Accessed Jun 1, 2020
  5. Ministry of Health and Social Affairs. Notice No. 81-34. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028124744#8. Published 1981. Accessed Jun 1, 2020
  6. Ministry of Health and Social Affairs. Notice No. 86-27. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028180794#7. Published 1986. Accessed Jun 1, 2020
  7. Ministry of Health and Social Affairs. Notice No. 88-15. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028207377#6. Published 1988. Accessed Jun 1, 2020
  8. Ministry of Health and Social Affairs. Notice No. 89-30. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028226444#31. Published 1989. Accessed Jun 1, 2020
  9. Ministry of Health and Welfare. Notice No. 1995-55. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028349719#8. Published 1995. Accessed Jun 1, 2020
  10. Kim J, Roh S. Development process of medical fee contract system of National Health Insurance and meaning of provider type-based fee contract system. Health Insurance Forum 2007;6:2-8
  11. Ministry of Health and Welfare. Notice No. 1999-32. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028469528#8. Published 1999. Accessed Jun 1, 2020
  12. Ministry of Health and Welfare. Notice No. 2000-67. Available at. http://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028496923#22. Published 2000. Accessed Jun 1, 2020
  13. Song BK. Action for resurrection of reading fee. Available at. https://www.monews.co.kr/news/articleView.html?idxno=5949. Published Oct 31, 2002. Accessed Jun 1, 2020
  14. Song SC. News of year 2002: radiation and reading fee. Available at. https://www.doctorsnews.co.kr/news/articleView.html?idxno=10440. Published Dec 16, 2002. Accessed Jun 1, 2020
  15. Ministry of Health and Welfare. Notice No. 2002-87. Available at. http://www.mohw.go.kr/react/jb/sjb0406vw.jsp?PAR_MENU_ID=03&MENU_ID=030406&CONT_SEQ=319481. Published 2002. Accessed Jun 1, 2020
  16. Ministry of Health and Welfare. Notice No. 2007-53. Available at. http://www.mohw.go.kr/react/modules/download.jsp?BOARD_ID=5900&CONT_SEQ=320062&FILE_SEQ=167425. Published 2007. Accessed Jun 1, 2020
  17. The Korean Society of Radiology. The 70 year history of the Korean Society of Radiology (1995-2015). 1st ed. Seoul: Ilchokak 2015
  18. Son JK. CT 15.5%, MRI 24% cost reduction. Available at. http://www.monews.co.kr/news/articleView.html?idxno=49862. Published Jun 26, 2012. Accessed Jun 1, 2020
  19. Health Insurance Review & Assessment Service. The benefit package of National Health Insurance 2007. Available at. http://www.hira.or.kr/sViewer/index.do?ebookSn=407. Accessed Jun 1, 2020
  20. Health Insurance Review & Assessment Service. The benefit package of National Health Insurance 2013. Available at. http://www.hira.or.kr/sViewer/index.do?ebookSn=147. Accessed Jun 1, 2020
  21. Ministry of Health and Welfare. Press release "from August, the average patient burden for physician surcharges will decrease by 35%". Available at. https://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=1&CONT_SEQ=300343. Published May 1, 2014. Accessed Jun 1, 2020
  22. Health Insurance Review & Assessment Service. The benefit package of National Health Insurance 2020. Available at. http://www.hira.or.kr/sViewer/index.do?ebookSn=577. Accessed Jun 1, 2020
  23. Yang DM. Second edition of research on relative value scales and cost reduction of radiologic tests. J Korean Soc Radiol 2017;77:205-210 https://doi.org/10.3348/jksr.2017.77.4.205
  24. Ministry of Health and Welfare. Notice No. 2013-144. Available at. http://www.mohw.go.kr/upload/viewer/skin/doc.html?fn=1380005450919_20130924155051.xls&rs=/upload/viewer/result/202009. Published 2013. Accessed Jun 1, 2020
  25. Ministry of Health and Welfare. Press release "from April, upper abdominal ultrasound for liver and gallbladder will be covered by the National Health Insurance, and patient burden for examination will be reduced by half". Available at. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=344188. Published Mar 13, 2018. Accessed Jun 1, 2020
  26. Ministry of Health and Welfare. Press release "from February 2019, lower abdominal ultrasound for kidney, urinary bladder and anus will be covered by the National Health Insurance, and patient burden for examination will be reduced by half". Available at. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=347165. Published Dec 31, 2018. Accessed Jun 1, 2020
  27. Ministry of Health and Welfare. Press release "from February 2020, patient burden for gynecology ultrasound for uterus and ovary examination will be reduced by half". Available at. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=352018. Published Dec 13, 2019. Accessed Jun 1, 2020
  28. Ministry of Health and Welfare. Notice No. 2004-92. Available at. http://www.mohw.go.kr/react/al/sal0101vw.jsp?PAR_MENU_ID=04&MENU_ID=040102&CONT_SEQ=31847. Published 2004. Accessed Jun 1, 2020
  29. Ministry of Health and Welfare. Press release "from 1st October, brain and neurovascular MRI will be covered by the National Health Insurance". Available at. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=346078. Published Sep 18, 2018. Accessed Jun 1, 2020
  30. Ministry of Health and Welfare. Press release "from 1st May, head and neck MRI will be covered by the National Health Insurance, and patient burden for examination will be reduced by 1/3". Available at. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=349271. Published Apr 30, 2019. Accessed Jun 1, 2020
  31. Ministry of Health and Welfare. Press release "from november, thorax and abdominal MRI will be covered by the National Health Insurance". Available at http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=350985. Published Sep 25, 2019. Accessed Jun 1, 2020
  32. Rubin GD. Costing in radiology and health care: rationale, relativity, rudiments, and realities. Radiology 2017;282:333-347 https://doi.org/10.1148/radiol.2016160749