Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Comparison Actual Conversion Factor with Estimated Conversion Factor by Fee Adjustment Model Reflecting Health Service Volume

서비스양을 고려한 수가 결정모형에 의한 추정 환산지수와 실제 환산지수의 비교

  • Han, Ki Myoung (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • Cho, Min Ho (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • Lee, Soo Jin (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • Chun, Ki Hong (Department of Preventive Medicine and Public Health, Ajou University School of Medicine)
  • 한기명 (아주대학교 의과대학 예방의학교실) ;
  • 조민호 (아주대학교 의과대학 예방의학교실) ;
  • 이수진 (아주대학교 의과대학 예방의학교실) ;
  • 전기홍 (아주대학교 의과대학 예방의학교실)
  • Received : 2013.09.17
  • Accepted : 2013.12.09
  • Published : 2013.12.31
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Abstract

Background: Price control alone may not successfully restrain growth in health expenditures. This study aimed to propose fee adjustment model suitable for Korea reflecting health service volume and to clarify applicability of the model by comparing actual conversion factor with estimated conversion factor from simulation of this model. Methods: Fee adjustment model was developed based on Alberta's fee adjustment formula in Canada and 7 alternatives were assessed according to diversely applied parameters of the model. Results: Estimated conversion factors of the tertiary care hospital and the hospital were lower than actual conversion factors, since the utilization of heath service has been increased. However, there was no big difference between estimated conversion factors and actual conversion factors of the general hospital and the clinic. Eventually this fee adjustment model could estimate proper conversion factor reflecting health service volume. Conclusion: This model may be applicable to the mechanism as determining conversion factor between insurer and provider via negotiation and controling growth in health expenditures.

Keywords

References

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