• 보건행정학회지
• /
• 제29권1호
• /
• pp.40-48
• /
• 2019

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

• 한국병원경영학회지
• /
• 제4권1호
• /
• pp.66-95
• /
• 1999

This study was conducted to analyze the medical charges of the elderly dementia inpatients, to identity their characteristics, and there by to evaluate feasibility of the per diem payment system for the patients. Data on medical charges of the patients were collected from the National Federation of Medical Insurance and sample hospitals from October through December 1997. The data were analysed in order to find the characteristics and test hypotheses postulated. The results are summarized as follows; Firstly, there was no difference statistically in between disease groups and between the dementia inpatients belonging to each disease group. Secondly, the amount of the non-insurance medical charges of the elderly dementia inpatients is considerably high compared to the insurance medical charges paid by the patient, which implies that some measures are to be prepared by the Government. Finally, medical charges per inpatient day of the dementia patients are not different statiscally by sex, by age group, and by disease group. This result supports the feasibility of the per diem payment system for the elderly dementia inpatients.

• 한국병원경영학회지
• /
• 제8권4호
• /
• pp.149-181
• /
• 2003

It has been asserted that per diem payment system should be introduced, in place of the current fee-for-service system, for payment of the inpatient services of the geriatric hospitals, Based on the assentation, this study aims at calculating costs and profits per inpatient-day of the geriatric hospitals, and thereby at contributing to the managerial improvement from the both sides of the Government and the hospitals. Relevant data of the three months, May to August, 2002 were collected from the five geriatric hospitals, and per inpatient-day costs and profits were calculated for the three disease groups. Major results and conclusions are as follow : Firstly, total costs per insured inpatient-day of the geriatric hospitals are 65, 389 won for dementia (including optimal profit of 3,858 won), 69,730 won for stroke (including optimal profit of 4,117 won), and 70,085 won for other diseases (including optimal profit of 4,134 won). Secondly, the amount of the non-insured costs per inpatient-day occupies 34.5% of the total costs for dementia, 30.3% for stroke, and 30.1% for other diseases. Thirdly, the total amount of the per inpatient-day costs calculated including the optimal profits is, on the average, higher by 12% than the present price level calculated for the current fee-far-service system. This implies that the present price level should rise by 12% when the current fee-far-service payment system be maintained, and Finally, introduction of a sliding-scale payment system should be considered for the inpatient medical management fees for the length of stay over six months or more that are being cut in the claim examination process by the insurance corporation.

• 보건행정학회지
• /
• 제33권4호
• /
• pp.379-388
• /
• 2023

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries' experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public's health and well-being in Korea.

• 한국산학기술학회논문지
• /
• 제20권11호
• /
• pp.324-334
• /
• 2019

본 연구는 일개 요양병원 입원 환자들의 의무기록 정보를 바탕으로 환자분류군에 따른 입원 환자 특성을 파악하고, 각 요인 간의 상관 관계를 분석하여 요양병원 환자분류 체계 개선에 필요한 기초 자료를 제공하고자 시행하였다. 연구 대상은 2016년 1월부터 12월까지 1년간 전북 지역 일개 요양병원에서 퇴원한 환자들의 의무기록 정보 총 213건으로 선정하였다. 재원일수와 상병 개수의 상관계수는 양의 상관 관계를 보여 환자가 가지고 있는 상병이 많을수록 재원일수가 길어지고 있음을 알 수 있었다. 이와 같은 연구 결과를 기반으로 환자분류군을 결정하는 환자평가표의 항목들을 실제로 환자에게 제공되는 의학적인 노력이 반영될 수 있도록 수정·보완하는 것이 필요하다. 또한 각 환자분류군별로 중점적으로 관리해야 할 문제점을 파악하여 각 분류군에 적합한 케어 서비스 체계를 수립하는 것이 효율적인 요양병원 운영을 위한 필수 요소이자 나아가 국가적 차원에서도 노인 인구의 건강을 관리하는 데 중요한 과제임을 알 수 있다.