• 제목/요약/키워드: Total medical reimbursement

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Occupational Injuries and Illnesses and Associated Costs in Thailand

  • Thepaksorn, Phayong;Pongpanich, Sathirakorn
    • Safety and Health at Work
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    • 제5권2호
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    • pp.66-72
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    • 2014
  • Background: The purpose of this study was to enumerate the annual morbidity and mortality incidence and estimate the direct and indirect costs associated with occupational injuries and illnesses in Bangkok in 2008. In this study, data on workmen compensation claims and costs from the Thai Workmen Compensation Fund, Social Security Office of Ministry of Labor, were aggregated and analyzed. Methods: To assess costs, this study focuses on direct costs associated with the payment of workmen compensation claims for medical care and health services. Results: A total of 52,074 nonfatal cases of occupational injury were reported, with an overall incidence rate of 16.9 per 1,000. The incidence rate for male workers was four times higher than that for female workers. Out of a total direct cost of $13.87 million, $9.88 million were for medical services and related expenses and $3.98 million for compensable reimbursement. The estimated amount of noncompensated lost earnings was an additional $2.66 million. Conclusion: Occupational injuries and illnesses contributed to the total cost; it has been estimated that workers' compensation covers less than one-half to one-tenth of this cost.

최근 10년 보건의료법 환경 및 건강보험법정책의 변화 (The Changes in the Public Health Laws and in the Legal Policies of the National Health Insurance over the Past Decade)

  • 김운묵
    • 의료법학
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    • 제10권2호
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    • pp.37-82
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    • 2009
  • Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

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Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea

  • Ahn, Yang Heui;Ham, Ok Kyung;Kim, Soo Hyun;Park, Chang Gi
    • 대한간호학회지
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    • 제42권7호
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    • pp.928-935
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    • 2012
  • Purpose: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Methods: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. Conclusion: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

산부인과 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험 연구 (A study of Simulations on the Changes of Physician's Practice Patterns in University Hospitals after the Introduction of DRG in Obstetrics and Gynecology)

  • 신삼철;김종수
    • 디지털융복합연구
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    • 제11권6호
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    • pp.289-298
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    • 2013
  • 본 연구는 2013년 7월부터 대학병원에서도 시작되는 산부인과 포괄수가제를 대비하여 일개 대학병원 산부인과에서 2012년 4월부터 2012년 9월까지 6개월 동안 산부인과 DRG에 속한 건강보험 환자군을 대상으로 진료행태의 변화를 모의실험을 통해 재원일수의 변화 가능성, 의료 서비스 제공량의 전이와 변화, 항생제를 포함한 약 주사 사용 및 각종 검사 등 항목별 처방량의 변화, 진료재료의 단가 조정 및 대체 효과의 가능성을 예측하였다. 약제비가 가장 변화폭을 보였으며 진료재료와 검사의 변화가 그 뒤를 이었다. 의료 서비스량 분석에서 재원일수의 단축은 의료비용의 감소로 혹은 병원의 수익성을 증가시킬 수 있는 요인으로 판단된다. 이러한 결과로 향후 산부인과에서 DRG 질병군에 대한 표준진료지침 개발에 기초 자료로 사용할 수 있을 것으로 사료되며, 진료의 효율성을 극대화시키고 비효율적인 병원자원 소모를 감소시켜 의료비용 절감 등 의료수익을 최대한 증대시키는 경영전략수립의 기초 자료 토대 마련이 가능할 것으로 사료된다.

5개 KDRG(한국형진단명기준환자군)에 대한 간호원가 산정 (Estimation of Nursing costs for Hospitalized Patients Based on the KDRG Classification)

  • 박정호;송미숙;성영희;함명림;윤선옥
    • 간호행정학회지
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    • 제3권2호
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    • pp.151-165
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    • 1997
  • A cost analysis for hospitalized patients was performed based on the KDRG classification in order to determine an appropriate nursing fee under the PPS(Prospective Payment System). The data was collected from 20 nursing units of three tertiary hospitals and two secondary hospitals from August 26 to September 15, 1996. The study consisted of 148 inpatients diagnosed for lens procedures(KDRG 03900), tonsillectomy &/or adenoidectomy(KDRG 16100), Cesarean section(KDRG 37000), or vaginal delivery(KDRG 37300) without any complications. The direct or indirect nursing hours of each patients were measured. Then, direct or indirect nursing expenditures of four nursing units, operating room and delivery room were computed. Finally, the resources used including average total nursing hours, average length of stay and average nursing cost of each KDRG were estimated as follows; 1) The average total nursing hours were 640 minutes for lens procedures, 403 minutes for tonsillectomy &/or adenoidectomy, 934 minutes for appendectomy with complicated principal diagnosis, 1,094 minutes for Cesarean section and 631 minutes for vaginal delivery. Significant differences were found in average total nursing hours among hospitals. 2) The average length of stay in lens procedures were 5 days, 4 days for tonsillectomy &/or adenoidectomy, 6 days for appendectomy with complicated principal diagnosis, 8 days for Cesarean section and 3 days for vaginal delivery. All results were within normal determined by the Ministry of Health and Welfare although significant differences existed among hospitals, especially with average length of stay for leng procedures between tertiary hospitals and secondary hospitals which was greater than for those of others. 3) The average nursing cost were 87,146 Won for lens procedures, 69,600 Won for tonsillectomy &/or adenoidectomy, 128,337 Won for appendectomy with complicated principal diagnosis, 151,769 Won for Cesarean section and 85,403 Won for vaginal delivery. These costs were 7.6%, 13.0%, 13.0%, 16.0% and 22.0%, respectively, of the official price fixed by the Ministry of Health and Welfare under the prospective payment system. Research for the analysis of nursing costs according to the severity of illness for those KDRGs shoud be carried out within the period of the PPS pilot project. In addition, a proper nursing fee schedule for a new reimbursement system based upon the result of the above research should be prepared in the near future.

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PET 이용 현황 및 전망 (Current Status and Future Perspective of PET)

  • 이명철
    • 대한핵의학회지
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    • 제36권1호
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

일개(K) 병원의 누락 조직검사결과지에 관한 조사연구 (A Study on Loose Laboratory Reports in A Hospital)

  • 유연순;하은희
    • 한국의료질향상학회지
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    • 제2권2호
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    • pp.46-54
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    • 1996
  • Background : The medical record is a compilation of pertinent facts of a patient's life and health history, including past and present illness and treatment. It is written by the health professionals contributing to that patient's care. And the medical record is the permanent, legal document which must contain sufficient information to identify the patient, justify the diagnosis and treatment, and record the results. As such, it must be accurate and complete. So we try to analyze the medical record especially a kind of incomplete record, loose laboratory reports. Methods: During the one-year period(from January to December 1988), a medical record practitioner examine and analyze the record of laboratory reports at K Hospital in Seoul. A total of 320 loose laboratory reports for 3,818 admitted laboratory reports. And a medical record practitioner and a physician review and analyze the influencing factors for the various reasons of clinical and laboratory aspects. Result: The loose percentage by department is the highest in obstetrics(40.4%) but the highest loose rate is in pediatrics(25.0%). The most of omission is occurred in operation room(80.3%) than OPD(19.7%). The change of diagnosis is according to duration of laboratory and more changable in cancer patient. Conclusion : Regular analysis of the documentation in the medical record so it fulfills its purposes of communicating patient care information. So it serves as evidence of the patient's course of illness and treatment for various legal, reimbursement, and peer evaluation review. And it is very important aspect of quality assurance in medical activities.

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간호수가 산정을 위한 상대가치를 이용한 수술실 간호행위 간호강도 분석 (Analysis of Nursing Intensity Related to Nursing Activities in Operating Room using the Relative Value Scale For Nursing Cost)

  • 하루미;권경자;우진하;김정아
    • 임상간호연구
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    • 제20권2호
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    • pp.162-176
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    • 2014
  • Purpose: The purpose of this study was to perform an operating room nursing activities analysis and estimate nursing intensity of each nursing activity based on the Relative Value Scale (RVS). Methods: The methodology for this study of RVS was based on the work of Hsiao et al. The first stage was to identify nursing activities and the second to measure intensity of nursing activities including technical skill, mental effort, and stress. Results: Calculation of the RVS for 99 nursing practices showed a score range from 300.00 to 1337.78. CS operation assistant, OS operation assistant, and obtaining certification had high nursing intensity. Surgical hand washing, putting on surgical gowns, surgical gloves and surgical caps and mask had low nursing intensity. Conclusion: The activities of operating room are not compensated separately but reimbursement is usually included in physician fees. In the future, an estimation of nursing cost should show the nursing contribution rate to total operation revenue.

복강경담낭절제술과 개복담낭절제술에 따른 진료량 비교 (A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital)

  • 이은미;유승흠;손명세;김석일
    • Journal of Preventive Medicine and Public Health
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    • 제28권2호
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    • pp.325-333
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    • 1995
  • Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.

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산부인과 의사의 일부 서비스 진료업무량 측정방법 비교에 관한 연구 (Comparison of work measures for some physician services in Obstetrics & Gynecology)

  • 허영주;손명세;박은철;강형곤;김한중
    • Journal of Preventive Medicine and Public Health
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    • 제28권3호
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    • pp.623-639
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    • 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.

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