• Title/Summary/Keyword: Medical fee

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Contents Analysis on the Dwellers' Medical Reports in High-Rise Mixed-Use Apartment (주상복합아파트 거주자의 질병자료에 관한 내용 분석)

  • Choi, Byung-Sook;Kang, In-Ho
    • Proceeding of Spring/Autumn Annual Conference of KHA
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    • 2008.04a
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    • pp.187-192
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    • 2008
  • This purpose of this study is to figure out the inter-relationship between the residence stories in high-rise mixed-use apartments and their residents' disease patterns throughout the dweller's medical reports in high-rise mixed-use apartments. Research basic data are obtained from medical fee request of National Health Insurance Corportion. Data are limited a housing complex to 'A' high-rise mixed-use apartment and a medical treatment time to 3 years(2004-2006). Analysis data of total 346,286 medical records, 43,159 disease records, and 8,999 persons are collected. By analyzing those data, findings are as follows: 1) Women is more medical treatments than men, 40-50 age group is more treated, and the residents of 6-25 stories are more received medical treatments. Diseases of the respiratory system and diseases of the eye and adnexa are relatively treated higher than other diseases. 2) The diseases of the respiratory system, the eye and adnexa, the skin and subcutaneous tissue, the ear and mastoid process), and the asthma have not relation to the high-storied residence through the data of disease records and personal records. But the analysis on the data of children, 7 ages and less, is showed a significant relation. And to conclude, there is no relationship between the residence of high-stories in that apartment and dwellers' disease patterns, but there is a little probable to the relationship in the pre-school child.

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Financial Projection of the Nursing Fee Differentiation Policy Improvement Proposal in the National Health Insurance: Using a Break-even Analysis Model for the Optimal Nursing Fee (적정 간호인력 등급별 입원료 추정 모델을 이용한 간호관리료 차등제 정책개선 재정부담 추계)

  • Kim, Sungjae;Kim, Jinhyun
    • Journal of Korean Academy of Nursing Administration
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    • v.19 no.5
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    • pp.565-577
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    • 2013
  • Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

A Model to Determine the Appropriate Monetary Redress for Accidents Involving Compensable Injury to Person

  • Kim, Seong-In
    • Journal of Korean Institute of Industrial Engineers
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    • v.1 no.2
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    • pp.65-72
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    • 1975
  • A System of evaluation is developed which determines a uniform and individualized monetary redress. It can be applied not only to permanent disability but to temporary disability cases and considers all factors affecting monetary redress in determining process. As objects of compensation this model considers five factors, the degree of injury, the change of earning capacity, medical fee, job suspension and the degree of contributory negligence. For each object is defined a subfunction measuring its magnitude. Then by assigning reasonable weighted values to these five subfunctions according to their relative importance, we get main function which determines appropriate monetary redress.

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Designing a Global Budget Payment System for Oriental Medical Services in the National Health Insurance (건강보험 한방의료의 총액계약제 도입방안)

  • Kim, Jin-Hyun;Kim, Eun-Hye;Kim, Yoon-Hee
    • Journal of Society of Preventive Korean Medicine
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    • v.14 no.1
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    • pp.77-96
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    • 2010
  • Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.

Comparative Analysis of Delivery Management in Various Medical Facilities (의료기관별 분만관리 양상의 비교 분석)

  • Park, Jung-Han;You, Young-Sook;Kim, Jang-Rak
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.555-577
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    • 1989
  • This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

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An Analysis of Determinants of Medical Cost Inflation using both Deterministic and Stochastic Models (의료비 상승 요인 분석)

  • Kim, Han-Joong;Chun, Ki-Hong
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.542-554
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    • 1989
  • The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to Prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation, The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory, The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment reduced the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.

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Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance (조산원(助産院)의 분만간호서비스에 대한 건강보험수가 산출방법과 적용방안)

  • Kim, Jin-Hyun;Jung, Yoo-Mi
    • Journal of Korean Academy of Nursing
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    • v.39 no.4
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    • pp.574-583
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    • 2009
  • Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Cost Analysis of Home Care with Activity-Based Costing(ABC) (활동기준원가계산[ABC]을 적용한 가정 간호 원가 분석)

  • Lee Su-Jeong
    • Journal of Korean Academy of Nursing
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    • v.34 no.6
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    • pp.1117-1128
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    • 2004
  • Purpose: This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. Method: The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. Result: The HHC activities were classified into 70 activities. In resource, the labor cost was 245₩per minute, operating cost was 9,570₩ per visit and traffic expense was an average of 12,750₩. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741₩ and the cost ranged from 55,560₩ to 74,016₩. Conclusion: The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

Dental implant cost by top-down approach (하향식(Top-down)방식을 적용한 치과 임플란트 원가산정)

  • Shin, Hosung;Kim, Min-Young
    • The Journal of the Korean dental association
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    • v.52 no.7
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    • pp.416-424
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    • 2014
  • The purpose of this study is to analyze the cost of dental implant by top-down method and, on that basis, to provide salient information for the suitable standard of dental insurance fee. A survey data and accounting documents from 36 samples of dental clinics secured with the organisation authority are used and analysed for extracting the representative sample of dental clinic. A researcher visited the dental clinics in person and conducted additional interviews in the omitted case of accounting documents. A dental implant cost by top-down method was estimated to 1,430,000 won. Labor cost accounted for 43% of the total cost structure, ranking it 1st and, management cost, material cost and interest cost on investment cost in order are investigated. Labor cost counts of the total cost that shows the similar aspect to the existing result. Cost in cost accounting of medical care would be used for the judge that cost pursed value for dental service, not price or fee.

Estimation of Nursing Costs by a Patient Classification System(PCS) in ICU (중환자 간호단위의 환자분류군별 간호원가 산정연구)

  • Sung, Young-Hee;Song, Mi-Sook;Park, Jung-Ho
    • Journal of Korean Academy of Nursing
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    • v.37 no.3
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    • pp.373-380
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    • 2007
  • Purpose: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. Method: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). Results: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. Conclusion: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.