• Title/Summary/Keyword: reimbursement system

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Nursing cost in Operating Room applying the Resource-Based Relative Value Scale(RBRVS) (수술간호행위별 상대가치(Resource-Based Relative Value)의 측정 및 간호수가 산정)

  • Kim, Myung-Soo;Kim, Young-Hae;Kim, Jung-Soon;Lee, Hae-Jung
    • Journal of Korean Academy of Nursing Administration
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    • v.8 no.2
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    • pp.283-293
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    • 2002
  • Purpose: The purpose of this study was to define cost-countable perioperative nursing activities and to analyze the cost of each nursing activities based on the Resource-Based Relative Value Scale (RBRVS). Method: Researcher and 3 research assistants observed and documented the 83 operating patients in order to measure nursing time for each of the perioperative nursing activities. And then, 35 operating room nurses with at least one year of perioperative nursing experience were observed for the RBRVS of perioperative nursing activities. Finally, the direct and indirect nursing costs were estimated. Result: Nursing costs of 25 nursing activities were estimated using the RBRVS. Most expensive nursing activities were delivery of the instrument and implement for OP team (9,780 won per hour) and behavior of wash, pack, disinfect the instrument (6,770). Conclusion: Based on the relative values of each perioperative nursing activities estimated in this study, proper medical reimbursement system should be established in a near future.

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Estimation of Nursing Costs Based on Nurse Visit Time for Long-Term Care Services (노인장기요양 방문간호서비스의 소요시간별 방문당 원가 분석)

  • Kim, Eun-Kyung;Kim, Yun-Mi;Kim, Myung-Ae
    • Journal of Korean Academy of Nursing
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    • v.40 no.3
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    • pp.349-358
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    • 2010
  • Purpose: The purpose of this study was to estimate nursing costs and to establish appropriate nursing fees for long-term care services for community elders. Methods: Seven nurses participated in data collection related to visiting time by nurses for 1,100 elders. Data on material costs and management costs were collected from 5 visiting nursing agencies. The nursing costs were classified into 3 groups based on the nurse's visit time under the current reimbursement system of long-term care insurance. Results: The average nursing cost per minute was 246 won. The material costs were 3,214 won, management costs, 10,707 won, transportation costs, 7,605 won, and capital costs, 5,635 won per visit. As a result, the average cost of nursing services per visit by classification of nursing time were 41,036 won (care time <30 min), 46,005 won (care time 30-59 min), and 57,321 won (care time over 60 min). Conclusion: The results of the study indicate that the fees for nurse visits currently being charged for long-term care insurance should be increased. Also these results will contribute to baseline data for establishing appropriate nursing fees for long-term care services to maintain quality nursing and management in visiting nursing agencies.

Analysis of Frequent Therapeutic Duplication Drug Classes Based on National Health Insurance Claimed Data in Korea (국내 건강보험심사청구자료에 근거한 다빈도 치료중복 의약품 약효군 분석)

  • Sohn, Hyun-Soon;Lee, Young-Sook;Choi, Kyung-Eob;Shin, Hyun-Taek
    • Korean Journal of Clinical Pharmacy
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    • v.20 no.3
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    • pp.262-267
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    • 2010
  • Therapeutic duplication of prescriptions is the most frequently reported inappropriate drug use in Korea. To prevent significant problems during drug prescribing and dispensing, prospectively, development of standard including drug lists considered as therapeutic duplications for the prioritized drug classes first would be necessary. This study was aimed to analyze frequent drug classes of therapeutic duplications by healthcare providers in clinical practice settings. National health claims data for drug review and reimbursement (1,426,065 prescriptions dated March 19, 2008) were analyzed. Therapeutic duplication was defined as the prescription including more than 2 ingredients belonging to the same KFDA drug classification numbers that considered to have therapeutic similarities. The following 3 drug classes were mostly frequent therapeutic duplication classes: 114 anti-pyretics, analgesics and anti-inflammatory drugs; 117 drugs for psycho-nervous system; 141 Antihistamines. About 3.5% of overall prescriptions analyzed showed therapeutic duplications. This result might be starting step to develop DUR therapeutic duplication standard.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance (조산원의 건강보험수가 산출방법과 추계)

  • Im, Hyo-Min;Kim, Jin-Hyun
    • Women's Health Nursing
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    • v.17 no.4
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    • pp.328-336
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    • 2011
  • Purpose: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. Methods: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. Results: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. Conclusion: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

Policy on Hospice and Palliative Care in Korea (말기암환자 완화의료정책 현황)

  • Chang, Yoon-Jung
    • Journal of Hospice and Palliative Care
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    • v.15 no.4
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    • pp.183-187
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    • 2012
  • The importance of palliative care for terminal cancer patients has been emphasized globally. Korea has formulated and implemented its policy for cancer control as it drew up a 10-year plan for cancer patient care. We examined Korea's National Cancer Act and the second 10-year plan for cancer patient care, which are legal grounds for palliative care projects for terminal cancer patients, to check the current status of Korea's efforts to establish a hospice and palliative care system. Institutionalization of hospice and palliative care has been developed within a framework of the national cancer project. Efforts such as expansion of hospice units, experts training and quality improvement should continue after the reimbursement of hospice and palliative care begins in 2013.

Lessons from Generic Promotion Policies in Other Countries (주요국의 제네릭 의약품 활성화 정책 고찰과 시사점)

  • Kim, Dong-Sook;Bae, Seungjin;Jang, Sunmee
    • Health Policy and Management
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    • v.23 no.3
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    • pp.210-223
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    • 2013
  • Backgrounds: Escalating pharmaceutical expenditure has threatened the sustainability of National Health Insurance system in Korea. Generic medicines allow patients to access safe, effective, high-quality medicines at low cost, thus insurers could achieve significant financial savings by promotion of generics, if they are priced much lower than the originator. The purpose of this study was to review generic pricing as well as promotion policies in other countries and assess the implication of those policies. Methods: We reviewed the main measures adopted by the developed countries such as Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, Netherlands, Norway, Sweden, United Kingdom, especially in countries where governments are the largest third-party payers or insurance finance resource is the national health insurance. Results: The foreign countries's experience with generic medicine policy shows that demand-side policies such as physician budgets, international nonproprietary name prescribing, generics substitution, patients co-payment as well as supply-side policies relating to pricing and reimbursement seems to play a critical role in developing the generic medicines market. Conclusion: Various strategy should be implemented to promote generic drug use.

The present and challenges of National Cancer Screening Program (국가 암 조기검진사업의 현황 및 발전 방향)

  • Park, Eun-Cheol;Gwak, Min-Seon;Lee, Ji-Yeong;Choe, Gwi-Seon;Sin, Hae-Rim
    • Journal of Korea Association of Health Promotion
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    • v.3 no.2
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    • pp.280-287
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    • 2005
  • The Government bean implementing the National Cancer Screening Program(NCSP) in 1999 and expanded its target population and target cancers. The target cancers of NCSP since 2004 are the five most common cancers in Korea: stomachm liver colorectal, breast, cervical cancer. One goal of the NCSP in 2005 is to include in its target population up to lower 50% of premiu of National Health Insurance. The Government and National Cancer Center have bee developing the protocol for the NCSP with associated related academic societies Health Centers operate the NCSP with National Health Insurance Cooperation. The Particioants of NCSP in 2004 are 1.34million, 14% of target population and the detection rate 2004 is 0.07%. NCSP has three challenges. Firstly, NCSP improves the participant rate through educating cancer screening increasing the access of screening(e.g. mobile screening unit), and increasing reimbursement fee Secondly NCSP assesses the quality of screening with related academic societies and implement the intervention for quality improvement. Thirdly, NCSP continues to increase the cost-effectiveness through modification of target population, screening interval, method, and information system.

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A Study of the stockpile and mobilization framework for the disaster management resources (재난관리자원 비축 및 동원 체계 연구)

  • Lee, Changyeol;Kim, Taehwan;Park, Giljoo
    • Journal of the Society of Disaster Information
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    • v.11 no.3
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    • pp.376-384
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    • 2015
  • It needs a framework to minimizing the damage using the just-time just-resources strategy. But it is not easy to put 'what kinds of resources', 'how many resources', 'from where institutions', and 'how much money for the reimbursement'. So most of the local government depends on the field manager. In this study, we analysed the conventional system and provides the efficient methodology to the stockpiling and mobilizing against to the disaster. The study does not provide the stockpile amount for the local governments, because the stockpile amounts must consider the local diverse situations.

A Study on the Current Status of Complementary Medicine in Australia (호주의 보완의학 현황에 관한 연구)

  • Yohan Ko;Byungmook Lim
    • Journal of Society of Preventive Korean Medicine
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    • v.28 no.1
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    • pp.13-30
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    • 2024
  • Objectives : This study aimed to investigate the history, current status, and regulation of complementary medicine in Australia. Methods : To investigate complementary medicine in Australia, we searched domestic and overseas academic databases, and websites of public and private organizations related to the Australian health care. Results : Complementary medicine consists of numerous services, among which massage and chiropractic care are significantly utilized by Australians. Since 2010, Australian healthcare practitioners, in the field of complementary medicine, have been supervised by the Australian Health Practitioner Regulation Agency (AHPRA). Those who AHPRA is responsible for managing acupuncturists, chiropractors, and osteopaths. Other professions are regulated by their own respective associations. Not only aforementioned services offered by specialists, but also consumption of oral supplements accounts for considerable portion of complementary medicine in Australia. Complementary medicine products, vitamins, and minerals are managed by the Therapeutic Goods Administration (TGA). In terms of insurance policy, the reimbursement of complementary medicine expenses in Australia is covered by the public healthcare insurance system, Medicare. Medicare covers acupuncture, chiropractic, and osteopathy services. Other complementary therapies are continuously reviewed to update their coverage under this scheme. Conclusion : In Australia, practitioner qualifications, education standards, and scope of procedures related to complementary medicine are systematically managed through legal regulations of the federal and state governments.

A Study of the Arbitration Issue on the KOREA and the U.S. FTA

  • Lee, Young Min
    • Journal of Arbitration Studies
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    • v.27 no.2
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    • pp.3-18
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    • 2017
  • International legal reviews on ISD, a procedure for resolving disputes under the Korea-US FTA, are examined from the perspective of law. If the ISD system does not exist, even if the investor suffers damage due to the illegal act of the host country, he or she must file a lawsuit through the court of the host country, which is unreasonable from the investor's point of view and makes it difficult to guarantee fairness and transparency. Some of the Koreans pointed out that there are some problems with the KORUS FTA dispute settlement regulations, and that the United States federal courts are taking a friendly attitude to the decisions made by the US Customs in determining the dispute by the KORUS FTA Agreement and the US Customs Act. In cases where the State does not violate international law but results in harmful consequences, the responsibility of one country is borne by the treaty. Foreign investment always comes with many challenges and risks. Therefore, the ISD system is a fair and universal arbitration system, which is considered to be a necessary system even for protecting the Korean companies investing abroad. In the investment treaty, compensation for the nationalization of foreign property and reimbursement under the laws of the host country were dissatisfied with foreign investors. In particular, some Koreans have pointed out that there are some problems in the KORUS FTA dispute resolution regulations and there is a need for further discussion and research. Based on the experiences and wisdoms gained in the course of Korea-US FTA negotiations, the dispute arbitration mechanism is urgently needed to reduce the possibility of disputes and to make amicable directions.