• Title/Summary/Keyword: 진료비청구

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A Study on Medical Fee System of the convalescent hospital -Focused on the case of patient group adjustment - (요양병원 수가제도에 대한 소고 -환자군 조정 판결을 중심으로 -)

  • Kwon, Hye Ok
    • The Korean Society of Law and Medicine
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    • v.18 no.2
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    • pp.195-218
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    • 2017
  • The increase in medical expenses for convalescent hospitals is increasing abnormally, which puts enormous burden on the National health insurance finances. This is a phenomenon that has been associated with the social phenomenon of rapid aging. The fact that the convalescent hospitals are paid the fixed amount per day for hospitalization became the incentive for some hospitals to use the patients as means of making money. And these hospitals intend to get regular care or take medicines at other hospitals in order to reduce medical expenses, even when the medical fee is paid. In order to prevent such financial leaks, the Health Insurance Review and Assessment Service adjusted the patient group for inpatients in a hospital with the above behavior, and then cut the cost of medical care benefits. However, Above decision was canceled by the court on the grounds that there was no basis rule. However, based on the above case, I think that it can be an opportunity to draw up the problem and to improve of the Medical Fee System of hospital. The modified medical fee system can strengthen the medical function of the convalescent hospital. In addition, it seems reasonable to exclude admission for "physically disabled group". Even if admission is allowed for the physically disabled group due to social needs, it should be excluded from the National health insurance for the fianacial soundness and the sustainability of the system.

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Survey of CT Practice and Collective Effective Dose Estimation (CT검사건수 및 CT검사에 의한 집단 실효선량의 추정)

  • Lee, Man-Koo;Lim, Cheong-Hwan
    • Journal of radiological science and technology
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    • v.33 no.3
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    • pp.231-237
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    • 2010
  • Computed tomography (CT) has been established as an important diagnostic tool in clinical medicine and has become a major source of medical exposure. A nationwide survey regarding CT examinations was carried out in 2007. Thanks to the appeasement policy regulating the import of CT scanners, there are 1,825 CT scanners across the country as of the end of March 2010, which means that we have 36.8 CT scanners per one million people. The annual number of examinations was 3.29 million, the number of examinations per 1000 population was 68. The most part of examinations was abdomen and pelvis. and the collective effective dose was in these parts. The effective dose per one population was evaluated as 0.952 mSv.

Design and Implementation of Mobile Medical Information System Based Radio Frequency IDentification (RFID 기반의 모바일 의료정보시스템의 설계 및 구현)

  • Kim, Chang-Soo;Kim, Hwa-Gon
    • Journal of radiological science and technology
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    • v.28 no.4
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    • pp.317-325
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    • 2005
  • The recent medical treatment guidelines and the development of information technology make hospitals reduce the expense in surrounding environment and it requires improving the quality of medical treatment of the hospital. That is, with the new guidelines and technology, hospital business escapes simple fee calculation and insurance claim center. Moreover, MIS(Medical Information System), PACS(Picture Archiving and Communications System), OCS(Order Communicating System), EMR(Electronic Medical Record), DSS(Decision Support System) are also developing. Medical Information System is evolved toward integration of medical IT and situation si changing with increasing high speed in the ICT convergence. These changes and development of ubiquitous environment require fundamental change of medical information system. Mobile medical information system refers to construct wireless system of hospital which has constructed in existing environment. Through RFID development in existing system, anyone can log on easily to Internet whenever and wherever. RFID is one of the technologies for Automatic Identification and Data Capture(AIDC). It is the core technology to implement Automatic processing system. This paper provides a comprehensive basic review of RFID model in Korea and suggests the evolution direction for further advanced RFID application services. In addition, designed and implemented DB server's agent program and Client program of Mobile application that recognized RFID tag and patient data in the ubiquitous environments. This system implemented medical information system that performed patient data based EMR, HIS, PACS DB environments, and so reduced delay time of requisition, medical treatment, lab.

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A Study on the Practice Model for Practical Education for Health and Medical Information Management (보건의료정보관리 실습교육을 위한 실습모델 연구)

  • Choi, Joon-Young
    • Journal of the Health Care and Life Science
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    • v.8 no.2
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    • pp.83-93
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    • 2020
  • In this study, a practical model for health information management education using the EMR education system at universities for nurturing health care information managers was studied. Currently, there is no practical training course for health care information management in the standards for evaluation and certification of health care information management education introduced to strengthen the job competency of health care information managers. Accordingly, the program was constructed so that the practice program suggested as an educational environment in the Health and Medical Information Management Education Evaluation and Certification Manual can be practiced in the EMR education system. In addition, a practical model that can be performed according to the on-site practice guidelines for health and medical information management for each program was studied. Using the health care information management education EMR system, master data management, patient registration, doctor prescription, medical cost calculation, health insurance claim management, form management, discharge registration, cancer registration, unrecorded management, health care data management, health care statistics, A practice model was studied so that practice on information protection/security management can be performed. It will be possible to play a role as a health care information management expert by raising the quality level of health care information management education through systematic and standardized health care information management practice courses at universities. Accordingly, it is necessary to cultivate health care information management experts who develop and manage medical services based on medical data analysis through practical training of health care information managers.

Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

  • Kim-Knauss, Yaeji;Jeong, Eunseok;Sim, Jin-ah;Lee, Jihye;Choo, Jiyeon;Yun, Young Ho
    • Journal of Hospice and Palliative Care
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    • v.22 no.4
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    • pp.145-155
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    • 2019
  • Purpose: Amendment to the Act on Decisions on Life-sustaining Treatment was recently enacted to designate long-term care hospitals as providers of hospice and palliative care. Despite its benefit of providing improved accessibility to end-of-life care, the amendment has raised concerns about its effect on quality of service. This study aimed to use information obtained from an expert group interview and previous studies to compare how cancer patients, family caregivers, physicians, and the general Korean population perceive the potential benefits and risks of this amendment. Methods: We conducted a multicenter cross-sectional study from July to October 2016. The included participants answered a structured questionnaire regarding the extent to which they agree or disagree with the questionnaire items indicating the potential benefits and risks of the amendment. Chi-square tests and univariate and multivariate logistic regression analyses were performed. Results: Compared with the general population, physicians agreed more that long-term care hospitals are currently not adequately equipped to provide quality hospice and palliative care. Family caregivers found improved access to long-term care hospitals more favorable but were more likely to agree that these hospitals might prioritize profits, thereby threatening the philosophy of hospice care, and that families might cease to fulfill filial responsibilities. Compared with the general population, cancer patients were more concerned about the potentially decreased service quality in this setting. Conclusion: Although potential service beneficiaries and providers expected improved accessibility of hospice and palliative care services, they were also concerned whether the system can provide adequate quality of end-of-life care.

Analysis of Grievance Handling for Medical Consumers: the Case of Dental-Care Institutions (치과진료기관의 고객 불만처리에 관한 실태분석)

  • Kim, Jin;Han, Ji-Hyoung
    • Journal of dental hygiene science
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    • v.7 no.3
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    • pp.147-152
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    • 2007
  • The purpose of this study was to examine how dental-care institutions responded to discontented customers and how much they provided grievance service and tried not to displease customers. After a survey was conducted on dental-care institutions from January 20 through February 20, 2007, the answer sheets from 206 respondents were analyzed with SPSS WIN 12.0 program, except four incomplete ones. The findings of the study were as follows: 1. 32.5 percent of the respondents were aware of grievance service, and 64.6 percent actually provided no grievance service. 94.7 percent had ever met customers who made a complaint. 2. The most common grievance of medical consumers was that it took long time to receive treatment and to wait for it. The second most dominant complaint was that the treatment they received was beyond the coverage of health-care insurance(30.6%). An insufficient medical explanation was the third most common grievance(6.3%), followed by excessive medical bills(5.8%). The most dominant number of monthly grievance case was one to ten(91.3%). As for how customers voiced their complaints, the largest number of customers talked employees about that in person(88.2%), and dental hygienists were mainly identified as a person who handled their grievance(56.8%). Concerning how the dental-care institutions responded to complaining customers, the largest number of the institutions took an immediate action(34.5%), and the second largest group took a measure after investigating the disposition of discontented patients(30.0%). The third greatest group just made an excuse(11.1%), and the fourth greatest group directed active efforts into taking care of complaining customers by offering grievance service (7.0%). 3. The dental-care institutions got a mean of 3.02 in grievance handling. The institutions that dental hygienists were in charge of grievance handling statistically significantly better responded to discontented customers than the others that receptionists were in charge of that(p < .01). The institutions that had no monthly grievance cases took care of discontented customers statistically significantly better than the institutions that faced one to ten grievance cases or 11 or more cases (p < .05). 4. The dental-care institutions got a mean of 2.59 in providing service of preventing customers from being dissatisfied. The institutions located in Seoul, Incheon and Gyeonggi province provided statistically significantly better service of that kind than the others located in the other regions(p < .01). And the dental-care institutions that dental hygienists were in charge of grievance handling offered statistically significantly better service of that kind than the dental-care institutions that receptionists were in charge of it(p < .05).

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Difference of perception of the duties of dental hygienist between dentists and dental hygiene students in an area (일개 지역 치과의사와 치위생학과 학생 간 치과위생사의 업무에 대한 인식의 차이)

  • Hwang, Soo-Jeong;Koong, Hwa-Soo;Lee, Sang-Hoon
    • Journal of Korean Academy of Dental Administration
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    • v.5 no.1
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    • pp.1-12
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    • 2017
  • Although dental hygienists have performed chair-side assisting and other dental cares as well as preventive dental cares in Korea, medical technician law confines duties of dental hygienists as closed narrative. The aim of this study was to investigate difference in perception of duties of dental hygienists in dental clinic between dentists and dental hygiene students. A total of 245 copies of questionnaires were distributed to dentists and students by post-mail. Only 42 dentists and 30 students in an area replied these questionnaires about the present and future duties of dental hygienists after providing written consent. Both groups agreed that intra and extra oral X-ray taking, education about oral health behavior, instruction after dental treatment, chair-side assisting, consulting for patients, scaling, initial impression taking, management of dental materials and equipment, sterilization of equipment, and receiving dental bills are duties of dental hygienists. However, they had different perceptions about various dental treatments as duties of dental hygienists even if they were under instructions of a dentist, including infiltration anesthesia, filling in cavity, intramuscular injection, FC change, canal irrigation, orthodontic treatment including separating, ligature bracket bonding and removing, setting crown and bridge, making individual, removing implant screw, and so on. These findings demonstrated that there were different perceptions about duties of dental hygienists between dentists and dental hygiene students, especially on dental treatment.

The Impact of Declining Profits on Closures of Pediatric Clinics (소아청소년과 의원의 수익 감소가 폐업에 미치는 영향)

  • Jeong-Yoon Oh;Su-Jin Cho;Hyun-Jung Byun;Choon-Seon Park;Jin-Suk Cho
    • Health Policy and Management
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    • v.34 no.1
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    • pp.38-47
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    • 2024
  • Background: Korea's population of children and adolescents has decreased by 2.88 million over the past decade and is expected to decline further due to the unprecedented low birth rate. In the fee-for-service compensation system, the decline in the pediatric population relates directly to the profit decrease in the pediatric clinics. This study analyzed whether the worsening profits of pediatric clinics impacted their closure. Methods: We built annual data for pediatric and other department clinics (internal medicine, otolaryngology, and family medicine) using the status of medical institute and health insurance claims data from 2012 to 2022. Then, we analyzed whether institutional variables such as annual profit and regional variables (Herfindahl-Hirschman index, the number of clinics per 100,000, etc.) affected the closure of clinics. The methods used in this study are descriptive statistics and chi-square analysis. Odds ratios for each variable were estimated by generalized estimating equations (GEE). Results: The closure rate of pediatric clinics was 2.66%-7.04% in 2012-2022, which was consistently higher than those of internal medicine, otolaryngology, and family medicine clinics. The profit gap per institution between the pediatric and the other clinics grew from 126 million won in 2012 to 245 million won in 2019. In the GEE analysis, profit decrease compared to the previous year with lower profit was the main factor that increased the closure of pediatric and other department clinics. After adjusting profit-related variables, the decrease in the pediatric population itself did not relate to the closure of pediatric clinics. The number of pediatric clinics or monopolies also did not affect the closure of pediatric clinics. Conclusion: The worsening profit is the crucial factor for the closure of pediatric clinics, while the pediatric population is decreasing. For this reason, it is necessary to actively seek ways to maintain a stable treatment system for children and adolescents.