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

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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A Study on the design of the outpatient and inpatient conversion factors based on the medical expenditure budget system

진료비 예산에 기초한 외래 및 입원 환산지수 설계에 관한 연구

  • O, Dongil (Department of Global Finance and Management, SangMyung University)
  • 오동일 (상명대학교 글로벌금융경영학과)
  • Received : 2019.11.22
  • Accepted : 2020.02.07
  • Published : 2020.02.29
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Abstract

In this paper, a theoretical model that separates one single conversion factor into two conversion factors for both outpatients and inpatients is introduced. By using hypothetical numbers, two conversion factors and an adjustment factor were calculated. The major implications are as follows. Firstly, by introducing two conversion factors, a minimum incentive mechanism for admitting outpatients to a clinic and high risk inpatients to a hospital was installed. Secondly, the introduction of two conversion factors decreased the drive to admit outpatients to a hospital by reducing the economic benefits for the hospital. Thirdly, it is possible to make explicit contracts for several factors rather than a single conversion factor, so that it can be used as an appropriate management tool for rapidly increasing medical expenses. Finally, this research can be used to set up policy tools to establish a proper healthcare delivery system in Korea by inducing behavioral changes in healthcare institutions.

본 연구에서는 단일 환산지수 체계를 유형별 외래 및 입원 환산지수로 분리하기 위한 이론 모형을 설계하였다. 그리고 가상 자료를 바탕으로 외래 및 입원 환산지수와 조정계수를 산출하였다. 본 연구에서의 중요한 결론은 다음과 같다. 첫째, 외래·입원 환산지수 개념을 도입하고 설계함으로써 의원은 외래, 병원은 중한 환자 위주의 입원 기능에 집중하도록 유도할 수 있는 최소한의 인센티브 도구를 도입할 수 있다. 둘째, 환산지수를 분리함으로써 상급종합병원을 비롯한 대형병원의 외래 진료비 수입이 목표 진료비 예산 이상으로 증가하더라도 병원수익 증대에 큰 도움이 되지 않도록 보상 체계를 설계할 수 있는 방안을 도입해 자원 배분 동기를 부여할 수 있다. 셋째, 단일 환산지수보다 다양한 요소들에 대한 명시적인 계약이 가능해져 급증하는 진료비에 대한 적절한 관리 수단으로 활용할 수 있다. 마지막으로 외래 및 입원 환산지수 분리 계약은 공급자의 행위론적인 변화를 유도해 의료전달체계를 정립하는데 기여할 수 있는 정책적인 도구로 활용될 수 있을 것이다.

Keywords

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