DOI QR코드

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Hourly wages of physicians within medical fees based on the Korean relative value unit system

  • Kim, Hyun Ah (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Jung, Sung Hoon (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, In Young (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Kang, Seong Hun (Department of Internal Medicine, Hallym University Sacred Heart Hospital)
  • 투고 : 2018.12.14
  • 심사 : 2019.03.15
  • 발행 : 2020.11.01

초록

Background/Aims: It is difficult to reach a social agreement on the appropriate level of compensation for professionals. This study was performed to examine the physician fee embedded in the relative value unit (RVU) system in comparison with the Korean hourly minimum wage. Methods: The Health Insurance Service Price and the Korean Classification of Procedural Terminology were used to obtain the hourly wages of physicians for designated health care services. In addition, the physician fee schedule at the United States Centers for Medicare and Medicaid Services and the Organisation for Economic Co-operation and Development (OECD) report on minimal wage were used. Health care service fees were selected based on laboratory, pathology, imaging, and procedure codes as well as examination fees. For calculation of physician labor costs per hour, physician workload × conversion factor was divided by the time involved. To calculate the proportion of physician labor fee in the total fee, the physician workload RVU for each service fee was divided by the total RVU. Results: A total of 27 physician fee codes were selected. Compared to the Korean hourly minimum wage in 2015, the average physician wages were greater by 2.80-fold for primary care and by 3.05-fold for tertiary care. The mean proportion of physician labor cost in the total cost was 0.19, which was significantly lower than that of corresponding procedures in the United States RVU (mean, 0.48). Conclusions: The average Korean physician wages compared to the hourly minimum wage were disproportionately low compared to the USA and other reference OECD countries.

키워드

과제정보

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI),funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI15C2699) and by the Hallym University Research Fund.

참고문헌

  1. Kang MS, Jang HS, Lee M, Park EC. Sustainability of Korean National Health Insurance. J Korean Med Sci 2012;27 Suppl:S21-S24.
  2. Jeong HS. Korea's National Health Insurance: lessons from the past three decades. Health Aff (Millwood) 2011;30:136-144. https://doi.org/10.1377/hlthaff.2008.0816
  3. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan 2009;24:63-71. https://doi.org/10.1093/heapol/czn037
  4. Flynn ML, Chung YS. Health care financing in Korea: private market dilemmas for a developing nation. J Public Health Policy 1990;11:238-253. https://doi.org/10.2307/3342754
  5. Soe SR, Choi ID, Moon SW, Kim JS, Hwang RI. Satisfaction survey of national health insurance, 2008. Wonju (KR): National Health Insurance Corporation, 2008.
  6. Lee HY, Park SE, Park EC, Hahm MI, Cho WH. Job satisfaction and trust in Health Insurance Review Agency among Korean physicians. Health Policy 2008;87:249-257. https://doi.org/10.1016/j.healthpol.2007.12.011
  7. DeVoe J, Fryer Jr GE, Hargraves JL, Phillips RL, Green LA. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? J Fam Pract 2002;51:223-228.
  8. Haas JS. Physician discontent: a barometer of change and need for intervention. J Gen Intern Med 2001;16:496-497. https://doi.org/10.1046/j.1525-1497.2001.016007496.x
  9. Zuger A. Dissatisfaction with medical practice. N Engl J Med 2004;350:69-75. https://doi.org/10.1056/NEJMsr031703
  10. Korean Medical Association. The Korean Classification of Procedural Terminology 2017 [Internet]. Seoul (KR): Korean Medical Association, c2017 [cited 2019 Oct 16]. Available from: http://kcpt.kma.org/.
  11. Centers for Medicare & Medicaid Services. Physician Free Schedule 2017 [Internet]. Baltimore (MD): Centers for Medicare & Medicaid Services, 2018 [cited 2019 Oct 16]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-ayment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-F.html.
  12. Organisation for Economic Co-operation and Development. Real minimum wages 2017 [Internet]. Paris (FR): Organisation for Economic Co-operation and Development, c2019 [cited 2019 Oct 16]. Available from: https://stats.oecd.org/Index.aspx?DataSet Code=RMW.
  13. Baadh A, Peterkin Y, Wegener M, Flug J, Katz D, Hoffmann JC. The relative value unit: history, current use, and controversies. Curr Probl Diagn Radiol 2016;45:128-132. https://doi.org/10.1067/j.cpradiol.2015.09.006
  14. Hsiao WC, Braun P, Dunn D, Becker ER. Resource-based relative values: an overview. JAMA 1988;260:2347-2353. https://doi.org/10.1001/jama.1988.03410160021004
  15. Beck DE, Margolin DA. Physician coding and reimbursement. Ochsner J 2007;7:8-15.
  16. Kang GW, Lee CS. The refinement project of health insurance relative value scales: results and limits. Korean J Health Policy Adm 2007;17:1-25.
  17. Tufano J, Conrad DA, Sales A, et al. Effects of compensation method on physician behaviors. Am J Manag Care 2001;7:363-373.
  18. Ebell MH. Future salary and US residency fill rate revisited. JAMA 2008;300:1131-1132. https://doi.org/10.1001/jama.300.10.1131
  19. Palmeri M, Pipas C, Wadsworth E, Zubkoff M. Economic impact of a primary care career: a harsh reality for medical students and the nation. Acad Med 2010;85:1692-1697. https://doi.org/10.1097/ACM.0b013e3181f5b754
  20. Irving G, Neves AL, Dambha-Miller H, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 2017;7:e017902. https://doi.org/10.1136/bmjopen-2017-017902
  21. Commonwealth of Australia. Medicare Benefits Schedule. [Internet]. Canberra (AU): Commonwealth of Australia, c2018 [cited 2019 Oct 16]. Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home.
  22. Kassenarztliche Bundesvereinigung. Bundesarztregister [Internet]. Berlin (DE): Kassenarztliche Bundesvereinigung, c2018 [cited 2019 Oct 16]. Available from: https://www.kbv.de/html/index.php.
  23. Caisse nationale de l'assurance maladie. Classification commune des actes medicaux [Internet]. Paris (FR): Caisse nationale de l'assurance maladie, 2019 [cited 2019 Oct 16]. Available from: https://assurance-maladie.ameli.fr/quisommes-nous/fonctionnement/organisation/cnam-tetereseau.