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http://dx.doi.org/10.5762/KAIS.2020.21.2.470

A Study on the design of the outpatient and inpatient conversion factors based on the medical expenditure budget system  

O, Dongil (Department of Global Finance and Management, SangMyung University)
Publication Information
Journal of the Korea Academia-Industrial cooperation Society / v.21, no.2, 2020 , pp. 470-478 More about this Journal
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.
Keywords
Conversion factor; Medical expenditure budget system; National Healthcare Insurance; Payment system; Healthcare delivery system;
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