Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Analysis of the Health Insurance Costs of Occupational Therapy in Stroke patients

뇌졸중 환자의 작업치료 보험수가 분석

  • Kim, Hyun-Jin (Dept. of Rehabilitation Standard & Policy, National Rehabilitation Research Institute) ;
  • Kim, Se-Yun (Dept. of Occupational Therapy, College of Health & Welfare, Woosuk University)
  • 김현진 (국립재활원 재활연구소 재활표준연구과) ;
  • 김세연 (우석대학교 보건복지대학 작업치료학과)
  • Received : 2014.09.22
  • Accepted : 2015.03.12
  • Published : 2015.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

This study examined health insurance costs of occupational therapy in stroke patients. The subjects were stroke patients, who underwent occupational therapy by hospitalization or out-patient centers in 2010. The cost of occupational therapy was analyzed from the insurance claims data of Health Insurance Review and Assessment Service in 2010. The kinds of occupational therapy were divided according to the insurance fee of occupational therapy in 2010. In-patients who received occupational therapy paid the highest rehabilitation treatment fee, whereas outpatients paid the highest nervous system function test fee. The cost of occupational therapy in the special rehabilitation treatment fee was highest by 25.3 billion won. The number of uses of general hospitals was the highest by 180 thousand but the total cost of long-term care hospital was highest by 10.4 billion won. The number of uses and cost by regional groups was highest in Seoul and Gyeonggi-do province. This study is meaningful in that a cost analysis of occupational therapy in stroke patients was performed for the first time using the stroke data from the whole country. The result can be used to provide basic data to improve the insurance fee in the future.

본 연구는 뇌졸중 환자의 작업치료 보험수가를 분석하고자 실시하였다. 연구대상자는 2010년 뇌졸중 유병자 중에서 의료기관에 입원하거나 외래로 작업치료를 받은 사람을 대상으로 하였으며, 작업치료 검사비용은 건강보험심사평가원의 2010년 보험청구자료를 주자료원으로 분석하였고, 작업치료의 종류는 2010년 작업치료보험수가를 토대로 구분하여 분석하였다. 연구결과 작업치료를 받은 인원은 입원의 경우 전문재활치료료가 가장 많았고 외래는 신경계기능검사료가 가장 많았다. 작업치료 비용은 전문재활치료료가 253억원으로 가장 많았으며, 병원종별 이용건수는 상급종합 및 종합병원이 18만건으로 가장 많았으나 총비용은 요양병원이 104억으로 가장 많았다. 보험종별로는 의료보험이 40만건으로 의료급여보다 많았으며 평균비용은 의료급여가 6만 1,626원으로 의료보험보다 더 많았다. 지역별 작업치료 이용건수와 비용은 서울과 경기가 가장 많았다. 본 연구는 전국 뇌졸중 환자의 자료를 이용하여 작업치료 비용을 분석한 최초의 연구라는 점에서 의의가 있으며 연구 결과는 향후 보험수가 개선에 필요한 기초자료로 활용될 수 있을 것이다.

Keywords

References

  1. Statistics Korea. Report on death causes 2010. Daejeon" Statistics Korea; 2010.
  2. H. J. Kim, Y. Kim, H. Y. Seo, E. J. Kim, S. J. Yoon, and I. H. Oh, "The economic burden of stroke in 2010 in Korea", Journal of the Korean Medical Association, Vol. 55, No. 12, pp. 1226-1236, 2012. DOI: http://dx.doi.org/10.5124/jkma.2012.55.12.1226
  3. H. Y. Kang, S. J. Lim, H. S. Suh, and D. Liew, "Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study", BMC public health, Vol. 11, No. 1, pp. 646, 2011. DOI: http://dx.doi.org/10.1186/1471-2458-11-646
  4. H. T. Hendricks, J. van Limbeek, A. C. Geurts, and M. J. Zwarts, "Motor recovery after stroke: a systematic review of the literature", Archives of physical medicine and rehabilitation, Vol. 83, No. 11, pp. 1629-1637, 2002. DOI: http://dx.doi.org/10.1053/apmr.2002.35473
  5. H. C. Dijkerman, M. Ietswaart, M. Johnston, and R. S. MacWalter, "Does motor imagery training improve hand function in chronic stroke patients? A pilot study", Clinical rehabilitation, Vol. 18, No. 5, pp. 538-549, 2004. DOI: http://dx.doi.org/10.1191/0269215504cr769oa
  6. G. Kwakkel, B. J. Kollen, J. van der Grond, and A. J. H. Prevo, "Probability of regaining dexterity in the flaccid upper Limb Impact of severity of paresis and time since onset in acute stroke", Stroke, Vol. 34, No. 9, pp. 2181-2186, 2003. DOI:http://dx.doi.org/10.1161/01.STR.0000087172.16305.CD
  7. U. Sveen, E. Bautz-Holter, K. M. Sodring, T. B. Wyller, and K. Laake, "Association between impairments, self-care ability and social activities 1 year after stroke", Disability & Rehabilitation, Vol. 21, No. 8, pp. 372-377, 1999. DOI: http://dx.doi.org/10.1080/096382899297477
  8. G. J. Hankey, and C. P. Warlow, "Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations", The Lancet, Vol. 354, No. 9188, pp. 1457-1463, 1999. DOI: http://dx.doi.org/10.1016/S0140-6736(99)04407-4
  9. P. Langhorne, and P. Duncan, "Does the organization of postacute stroke care really matter?", Stroke, Vol. 32, No. 1, pp. 268-274, 2001. DOI: http://dx.doi.org/10.1161/01.STR.32.1.268
  10. D. T. Wade, "Stroke: rehabilitation and long-term care", The Lancet, Vol. 339, No. 8796, pp. 791-793, 1992. DOI: http://dx.doi.org/10.1016/0140-6736(92)91906-O
  11. S. A. Cermak, C. A. Trombly, J. Hausser, and A. M. Tiernan, "Effects of lateralized tasks on unilateral neglect after right cerebral vascular accident", Occupational Therapy Journal of Research, Vol. 11, No. 5, pp. 271-191, 1991. https://doi.org/10.1177/153944929101100502
  12. D. Dirette, and J. Hinojosa, "Effects of continuous passive motion on the edematous hands of two persons with flaccid hemiplegia", American Journal of Occupational Therapy, Vol. 48, No. 5, pp. 403-409, 1994. DOI: http://dx.doi.org/10.5014/ajot.48.5.403
  13. Korean Society of Occupational Therapy. Medical insurance fee of occupational therapy[Internet]. Seoul: Korean Society of Occupational Therapy, 2010. Available From: http://www.kaot.org, (accessed Aug, 10, 2010).
  14. H. S. Choi, H. G. Kang, M. Y. Jung, W. S. Jung, Y. M. Chae, and Y. G. Ji, "A cost-benefit analysis on home-based occupational therapy for stroke patients", Journal of Korean Society of Occupational Therapy, Vol. 15, No. 2, pp. 13-24, 2007.
  15. H J. Kim, D. H. Kim, and J. I. Moon, "Cost analysis of home-rehabilitation in stroke", Journal of the Korean Aging Health Freindly Policy Association, Vol. 2, No. 1, pp. 35-43, 2010.
  16. J. Leal, R. Luengo-Fernandez, A. Gray, S. Petersen, and M. Rayner, "Economic burden of cardiovascular diseases in the enlarged European Union", European Heart Journal, Vol. 27, No. 13, pp. 1610-1619, 2006. DOI: http://dx.doi.org/10.1093/eurheartj/ehi733
  17. Y. D. Kwon, H. Chang, Y. J. Choi, and S. S. Yoon, "Nationwide trends in stroke hospitalization over the past decade", Journal of Korean Medicine Association, Vol. 55, No. 10, pp. 1014-1025, 2012. DOI: http://dx.doi.org/10.5124/jkma.2012.55.10.1014
  18. National Health Insurance Corporation, Ministry of Health & Welfare [Internet]. Seoul: National Health Insurance Corporation, 2010 [cited 2010 April 5], Available From: http://stat.mw.go.kr/front/include/download.jsp?bbsSeq=4&nttSeq=14626&atchSeq=1657, (accessed Oct., 29, 2014)
  19. Y. Kim, N. J. Moon, S. W. Park, J. H. Park, J. H. Park, H. Y. Shin, B. S. Lee, S. H. Ho, S. J. Moon, J. H. Lee, and S. H. Hwang. A study on improvement plans of rehabilitation-health service system for the Handicapped. Ministry of Health & Welfare, Seoul, Korea, 2009.
  20. National Health Insurance Corporation, Ministry of Health & Welfare. National Health Insurance Statistical Yearbook. Seoul, Korea, 2014.
  21. D. H. Lee, E. C. Park, C. M. Nam, S. G. Lee, D. H. Lee, and S. H. Yu, "Comparing difference of volume of psychiatric treatments between the patient with health insurance and those with medical assistance: for inpatients of Korean psychiatric hospitals', Korean Journal of Preventive Medicine, Vol. 36, No. 1, pp. 33-38, 2003.
  22. M. Y. Jung, and Y. J. Cha, "An analysis on the status and supply-demand of occupational therapist in Korea", Journal of Korean Society of Occupational Therapy, Vol. 17, No. 4, pp. 113-126, 2009.

Cited by

  1. Factors affecting the hospital profitability (Focusing on the convergence of differences in financial performance of the surplus and deficit hospital) vol.13, pp.11, 2015, https://doi.org/10.14400/JDC.2015.13.11.267