• Journal of Oral Medicine and Pain
• /
• 제30권2호
• /
• pp.257-268
• /
• 2005

우리나라 건강보험제도는 보수지불방식에서 전체적으로 보면 행위별수가제(fee for service)를 유지하고 있다. 이 제도에서는 진료수가의 설계에서 각 의료서비스의 단위를 설정하기 위해서는 현재 임상에서 이루어지고 있는 모든 의료행위에 대한 목록이 필요하게 된다. 따라서 본 연구에서는 측두하악장애 의료의 수가구조와 수가항목에 대해 재분류를 통한 체계화과정을 통해서 향후 투입자원에 기초한 상대가치를 산정하여 수가수준을 결정할 수 있는 준거를 제시하고자 하였다. 현행 행위별 수가제도의 범위내에서 측두하악장애 진료행위에 대한 델파이법을 이용하여 의료행위에 대한 재분류하여 항목화 작업을 거치면서 자원기준 상대가치 산출모델의 선행연구를 시행하였다. 이를 통해 의료행위분류에서는 총 151개의 의료 행위를 규명하였다. 이를 건강보험 수가항목이 되도록 하기 위해서는 지속적인 정련화 과정이 필요하게 되므로 용어의 정리 및 통일, 명확한 진료범위의 설명, 체계적인 분류구조 등이 고려되어야 한다. 이상의 연구결과는 향후 치과의료의 구조적 문제점과 현안과제를 해결하는 기초자료로 활용하고, 앞으로 치과의료의 수가 수준을 결정하는 후속연구의 방향설정과 참고자료로 활용하며, 의료수가체계의 표준화를 유도하여 의료이용의 편의성을 도모하고 의료정책에 대한 국민적 신뢰를 회복하여 측두하악관절장애 진료의 건강보험 확대적용 및 향후 민간 사보험 도입시 기초자료로 활용될 것으로 사료된다.

• 대한치과의사협회지
• /
• 제53권4호
• /
• pp.266-274
• /
• 2015

The price for health service are decided by very complicated process because many of factors are related with them. The RBRVS(resource-based relative value scale) were used to calculate the Korean health service fees including dental fees. This study aimed to compare dental fees of Korea with other countries, such as Japan, Germany, and the US for evaluating the adequacy. Dental fees were categorized as oral evaluation and imaging, dental treatment including restorative, periodontal, and surgical work, and preventive treatment and compared by each country. The official documents about dental fees were collected from Korea, Japan, Germany, and the US. Each fee was presented as their own currency at first. Then they were converted into Korean won (KRW) by applying the market exchange rates at a specific point of time. Finally the fees were adjusted by purchasing power parities (PPPs) which equalize the different currencies. In general, the level of Korean fees were markedly low compared to those of Japan, Germany, and the US. German fees were similar or higher than that of Japan, and the US. The Korean fees were lower than three other countries 1.2~4.1 times for oral evaluation and 2.2~7.3 times lower for panoramic radiography. The endodontic fees of Japan, Germany, and the US were higher 1.8~15.3 times and 4.0~35.9 times for the deciduous teeth extraction compared to the Korean. In Japan the prophylaxis was 3.2 times more priced than the Korean fee. Exceptionally, the fees for re-evaluation, amalgam filling, and scaling were lower priced in Japan than other countries. This study has limitations on the items in definition and contents of dental practices units which were not exactly comparable and differently determined by countries. However, this study is meaningful because it surveyed the price levels to compare four different countries and then applied PPPs adjustment. This finding can be used to develop the dental RBRVs of Korean national health insurance and will contribute to improving the payment systems of health care.

• Journal of Preventive Medicine and Public Health
• /
• 제28권3호
• /
• pp.623-639
• /
• 1995

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG) and Resource-based .elative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called' total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the' Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, We used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in Korea. And also with the thankful help of Advisory Committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaires', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than 'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's characteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.

• 한국산림과학회지
• /
• 제82권2호
• /
• pp.176-187
• /
• 1993

천연활엽수림(天然闊葉樹林) 군집(群集)에서 수종(樹種)의 천이계열(遷移系列)상의 위치를 해석(解析)하기 위하여 84개 활엽수(闊葉樹) 교목(喬木) 및 관목(灌木) 수종들의 생태형태학적(生態形態學的) 특성 분석을 바탕으로 극성상지수(極盛相指數)를 추정(推定)하였다. 생태형태학적(生態形態學的) 특성은 천이(遷移) 단계와 관계있다고 판단한 19가지를 선정하였으며, 각 수종별로 특성마다 극성상으로 갈수록 증가하는 2-4단계의 표준화된 점수를 부여하고 총점에 대한 합계점수의 백분율로써 극성상지수(極盛相指數)로 삼았다. 연구 대상 수종 중에서 서어나무의 지수(指數)가 83.3으로 최고치를 기록하였고 사시나무의 지수(指數)가 18.8로써 최저치로 추정되었으며, 전체 지수(指數)의 평균(平均)은 54.2로 산출되었다. 70이상의 지수(指數)값을 나타낸 수종은 9개, 40이상 70미만의 지수(指數)값을 나타낸 수종은 58개, 그리고 40미만의 지수(指數)값을 나타낸 수종은 17개로 집계(集計)되어, 천이(遷移) 중반단계의 삼림이 갖는 다양한 자원(資源) 혹은 생태적(生態的) 지위(地位)(niche)를 이용하는 수종(樹種)의 수가 압도적으로 많음을 알 수 있다. 주성분분석(主成分分析)을 통하여 각 수종이 광선흡수(光線吸收), 번식(繁殖), 그리고 목재(木材) 성질(性質) 등의 요인(要因)에 따르는 위치를 3차원(次元) 좌표(座標)상에 ordination하였고, cluster분석(分析)을 통하여 유사(類似)한 특징을 가진 4가지 수종군(樹種群)을 분류(分類)하였다. 과(科)별로 극성상지수(極盛相指數) 범위를 파악한 결과, 자작나무과(科)와 단풍나무과(科)에 속하는 수종들의 지수(指數) 범위가 넓었고, 버드나무과의 수종들은 선구수종의 전형적인 특성을 나타내었으나, 특별히 극성상(極盛相) 생활형(生活形)의 수종군(樹種群)을 갖는 과(科)는 없었다.