• Title/Summary/Keyword: 건강보험진료비

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Comparative Analysis of Medical Use of Spine Specialty Hospitals and Nonspecialty Hospitals (척추전문병원과 비전문병원의 의료이용 비교분석)

  • Young-Noh Lee;Yun-Ji Jeong;Kwang-Soo Lee
    • Health Policy and Management
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    • v.34 no.1
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    • pp.26-37
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    • 2024
  • Background: The purpose of this study was to compare and analyze the differences in charges and length of stay per case between spine specialty hospitals and non-specialty hospitals, and to identify the factors that influenced them. Methods: This study used claims data from the Health Insurance Review and Assessment Service, including inpatient visits from January 2021 to December 2022. The healthcare facility status data was used to identify the characteristics of study hospitals. Multilevel analysis was conducted to identify factors associated with the charges and Poisson regression analysis was conducted to analyze the length of stay between spine specialty hospitals and non-specialty hospitals. There were 32,015 cases of spine specialty hospitals and 17,555 cases of non-specialty hospitals. Results: For four of five common spinal surgeries, specialty hospitals shaped longer length of stay than those of non-specialty hospitals. Multilevel and Poisson regression analysis revealed that regardless of the type of surgery, higher age and higher Charlson comorbidity index scores were significantly associated with an increase in both the charges per case and length of stay (p<0.05). However, when hospitals were located in metropolitan areas, there was a significant decrease (p<0.05). Conclusion: This study found that specialty hospital had higher inpatient charges and loner length of stay contrary to the previous study results. Further studies will be needed to find which contribute to the differences.

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.

The Effects of Urban Land Use and Housing Form on Residents' Mental Health - Focusing on the Mental and Behavioral Disabilities Expense (F-code) in Jeonju-city (토지이용과 주택유형이 정신건강에 미치는 영향 연구 - 전주시 국민건강보험공단의 정신건강 진료비(F-code)를 중심으로 -)

  • Yu, Hyun-A;Kim, Young-Suk;Yang, Seung-Woo
    • Journal of the Korean Institute of Rural Architecture
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    • v.14 no.4
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    • pp.89-96
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    • 2012
  • The purpose of the study is to identify land use characteristics which have influence on residents' mental health. Land use and housing types indicators including green areas and parks were selected by analyzing the related environment and health researches. Research database for every variable from 33 neighborhoods in Jeonju city were established through National Health Insurance Corporation, where is available for getting mental and behavioral disabilities (F code) expenses. The relation between those indexes and mental health were analysed. The findings of this study are as follows : First, the higher price area like apartments and raw houses the residents lived in, the more expenditure of F-code was paid. It could be interpreted by the relatively high frequency of medical treatment and interests on the health. Second, the more green area except park were there, the more F-code expenditure was given, which could be explicated with the spatial co-relation between location of green area and apartments of Jeonju city. It was very high, and apartment element's affect on the F-code was much more than the green zone. Third, the nearer to park were the residents, the less F-code expenses was paid.

Analysis of Factors which Affect the Medical Utilization Fee after an Increase of Health Insurance Benefits for Patients with Serious Illnesses (건강보험 중증질환 급여확대 전후에 따른 진료비 차이에 관한연구)

  • Lee, Jung-He;Lee, Moo-Sik;Kim, Jee-Hee;Moon, Tae-Young;Kim, Yong-Ha;Kim, Kwang-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.4
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    • pp.1504-1510
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    • 2010
  • According to a research analysis of the factors which affect the medical utilization fee after an increase of health insurance benefits for patients with serious illnesses based on 225 patients over 6 months, both before and after the increase of benefits, from January, 1st, 2005 to June 30th, and also from January, 1st, 2006 to June 30th. In terms of genders, 67.8% of males were affected, whereas only 32.2% of females were effected, a much higher rate of men than women. Men also had higher rates before and after the increase of benefits. Out of 5 categories related to medication and treatment, radiation testing was the most expensive at about 5,300,000, operation fees were 590,000, and costs of other testing approximately 200,000 with the least expensive category being 120,000 for medication. By looking at the relationship between the fees and increase of benefits, medication was a hospital charge (p<0.01), injection fees were hospital charges (p<0.01), operation fees were hospital charges (p<0.01). Medication fees (p<0.01) and injection fees (p<0.01) were found to be related.

How Much should the Poor Pay for their Health Care Services under the National Health Insurance System? (계층간 진료비 본인부담의 형평성에 관한 연구)

  • Kim, Hak-Ju
    • Korean Journal of Social Welfare
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    • v.56 no.3
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    • pp.113-133
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    • 2004
  • Although National Health Insurance(NHI) in the South Korea has guaranteed access to health insurance coverage to virtually all the people, a significant portion of out-of-pocket spending can create substantial financial burdens for some beneficiaries, particularly those with low incomes. Previous studies have estimated the magnitude of out-of-pocket spending by types of chronic illness or in- and out-patients. Prior estimates, however, have not given a complete picture of the impact of health care costs on lower-income populations. The result from this study shows that 20 percent of beneficiaries in the lowest-income quintile spent more than twelve percent of their household equivalent income out-of-pocket health services, whether they were enrolled in a Health care services or not. In comparison, the beneficiaries in the highest-income quintile level spent only 2 percent of their income out-of-pocket on health care. Also, the regression analysis suggests that age, household income, number of chronic illness, type of hospital in addition to the number of usage may affect the size of out-of-pocket spending.

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구강건강관리

  • KOREA ASSOCIATION OF HEALTH PROMOTION
    • 건강소식
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    • v.26 no.6 s.283
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    • pp.6-13
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    • 2002
  • 최근 우리나라 의료보험재정에서 구강진료비로 사용된 액수가 1990년에 1,869억원이었고, 1994년에 2,786억원, 1995년도에 3,507억원, 1998에는 5,986억원, 1999년에는 6,778억원으로 지난 10년간 계속 증가하는 양상을 보이고 있다. 그러나 치아우식증과 치주병으로 인하여 발거된 치아를 보철하는 비용은 이 치료비보다 훨씬 많을 것으로 추정되고 있어서 구강건강 관리비가 국민에게 부담이 되고 있을 것으로 추정된다. 과거부터 치아건강이 오복의 하나에 들 만큼 소중함에도 불구하고 여전히 치아우식증(충치)를 포함한 구강질환은 우리나라 사람의 다빈도 질환으로 자리 잡고 있다. 이달의 건강 길라잡이에서는 6월 9일 ‘치아의 날’에 즈음하여 일반적인 구강건강과 특히 청소년기 치아건강의 중요성을 새롭게 인식함으로써 외상으로부터 치아를 보호하여 평생 치아건강으로 적극적인 건강생활을 실천하는 계기를 마련하고자 한다.

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A Comparative Study on Total Payment of Mental and Behavioral Disorders Patients Admitted through the Emergency Room: Focusing on Main & Sub Sick (응급실 경유 정신 및 행동장애 입원환자들의 총진료비 비교 : 주상병과 부상병 환자 중심으로)

  • Choi, Hyun-Sik;Lee, Hyun-Sook
    • The Journal of the Korea Contents Association
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    • v.14 no.10
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    • pp.562-569
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    • 2014
  • The purpose of this study was to investigate the determinants of total payment for mental and behavioral disorders patients admitted through the emergency room. Study data was selected from the Korean National Health Insurance sample data in 2009. This data was consisted of 753 inpatients who are 331 inpatients with only main sick(F31-F39) and 422 inpatients with main sick codes(F31-F39) and sub sick(F00-F99) admitted through the emergency room. SPSS v.18 was used for the statistical analysis such as descriptive analysis, t-test, ANOVA, and multiple regression analysis. In multiple regression analysis, significant variables affecting total payment of main sick patients were gender(p<.01), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). Also, main sick patients with sub sick were gender(p<.01), age(p<.001), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). These findings implied that it is necessary to build short, middle, and longterm program and system for high risk mental and behavioral disorders groups.

Comparison of Inpatient Medical Use between Non-specialty and Specialty Hospitals: A Study Focused on Knee Replacement Arthroplasty (전문병원과 비전문병원 입원환자의 의료이용 비교 분석: 인공관절치환술(슬관절)을 대상으로)

  • Mi-Sung Kim;Hyoung-Sun Jeong;Ki-Bong Yoo;Je-Gu Kang;Han-Sol Jang;Kwang-Soo Lee
    • Health Policy and Management
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    • v.34 no.1
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    • pp.78-86
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    • 2024
  • Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use of inpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021-2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. The dependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable was whether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type, surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number of orthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospital showed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital, indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. In our study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the cost-effectiveness of specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals in metropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designating specialty hospitals in non-metropolitan areas, such as introducing "semi-specialty hospitals (tentative name)," will lead to a reduction in health disparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals' medical staff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriately allocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.

치과병원 증가, 양질 진료 서비스냐, 과다 진료비 청구냐

  • The Korean Dental Association
    • The Journal of the Korean dental association
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    • v.38 no.10 s.377
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    • pp.935-941
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    • 2000
  • 건강보험심사평가원이 파악한 전국의 치과병원 개수는 48개(대학의 치과병원, 국공립 치과병원 제외) 이중 올해 새로 개설신고한 치과병원이 16개에 이른다. 치과병원의 증가로 치과의사의 활로 개척 및 수련기회의 증가, 연계된 진료 및 질 높은 진료 가능 등 긍정적 측면도 있으나 과다한 시설투자로 인한 지나친 요금 청구, 주변 개원의와의 마찰, 과대광고의 가능성 등 문제점도 제기되고 있다. 이에 치과병원의 현황을 살펴보고 치과병원의 긍정적인 측면과 부정적인 측면 등을 살펴보도록 한다.

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Impact of Competition on Physician Behavior Clinics - Focused on Acute Otitis Media in Children - (의원급 의료기관 간 경쟁이 진료행태에 미치는 영향 - 유·소아 급성중이염 중심 융합연구 -)

  • Lee, Chae-Kyung;Suh, Won-Sik
    • Journal of the Korea Convergence Society
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    • v.9 no.1
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    • pp.151-159
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    • 2018
  • This study analyzes the impact of competitions clinics on the total treatment cost and anti-biotics prescription rate. The result of implementing the basic statistics, correlations, and regression analysis by facilitating the evaluation data by Health Insurance Review & Assessment Service in 2015 for acute otitis media in children is shown as follows. First, there is a significant difference for each si-gun-gu for the competition index between total treatment cost and clinics, but there is almost no significant difference for the anti-biotics prescription rate. Second, competition in clinics has statistically important impact on the total examination cost And, third, competition in clinics has no statistically important impact on the anti-biotics prescription rate. There is a need for additional studies on re-examination rate, treatment cost per visit and so forth in order to clarify other factors of competition for medical institutions impacting on the physician behavior in the future studies.