• Korean Journal of Acupuncture
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• 제24권3호
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• pp.67-79
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• 2007

Objectives : The Purposes of this study were to investigate payment system for oriental medical treatment as supplier of medical services, and to estimate reasonable levels of medical fee. Methods : This study made these following results by reviewing the answers which were given by 172 Korea traditional doctors from March 1 to April 15, 2006. Results : General satisfaction of payment system for oriental health insurance was $2.17{\pm}1.01$ $(mean{\pm}SD)$ on a 1-7 scale (median 4) as very low level. Reasonable medical fees which were answered by 172 Korea traditional doctor are higher than present fees, thus Korea traditional doctors think that present fees should be increased. And according to the survey, current insurance fees have a problem of disparity between each treatment fee. Conclusions : According to results of this study, current fees of oriental medical treatment are not rational. And this problem leads to distortion of medical treatment. Additional studies in thls field are needed.

• 대한한의학회지
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• 제34권1호
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• pp.35-51
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• 2013

Objectives: The purpose on this study was to analyze medical health insurance to provide useful data to reestablish oriental medical insurance fees for long-term care hospitals. Methods: First, comparative analysis on medical health insurance was performed, calculating insurance fees of patients admitted to Mungyung Long-term Care Hospital. The oriental medical insurance fee of the patients was calculated as if the patients have been admitted to oriental long-term care hospitals, and the ratio of oriental medical insurance fee to western was calculated. Results: 1. The ratios of total medical expenses were 90% within 3 months and 82% over 3 months. 2. The ratios of co-pays were 86% within 3 months and 82% over 3 months. Conclusions: Oriental medical insurance fees need to be reevaluated.

• 대한정형도수물리치료학회지
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• 제6권2호
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• pp.5-13
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• 2000

The purpose of this study is to suggest reasonable medical insurance fees for orthopaedic manual therapy. This medical insurance fees include of direct and indirect costs. The reasonable medical insurance fees of orthopaedic manual therapy are as follows. 1. Spinal manual therapy fee is 10.173 won. 2. Upper and lower extremity manual therapy fee is 10,173 won. 3. Hand and foot manual therapy fee is 6.782 won. 4. Hand and visceral manual therapy fee is 6.782 won.

• 대한한의학회지
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• 제29권1호
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• pp.15-24
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• 2008

Objectives : The purpose of this study is to reexamine current oriental medical treatment fees based on valuation of input resources which are the treating time, the treatment's difficulty, and the material cost. Methods : This study obtained the following results by reviewing the answers given by 172 oriental medical doctors from March 1 to April 15, 2006. To investigate material cost, we took inventory of treatment materials used by 2 oriental hospitals. Results : The current system does not reflect well enough the treating time and treatment's difficulty. Considering current oriental treatment fees, material costs are too much of doctors' fees. Especially, Wang-ssuk-dduem, which is another form of moxibustion treatment, was spent as much as 74.6% on materials cost. Conclusions : The findings suggest the current oriental treatment fees should be revised to reflect the actual input resources into oriental medical doctor activities and to avoid a distortion of physicians' behavior.

• 보건의료산업학회지
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• 제9권1호
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• pp.57-66
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• 2015

This study was performed to provide efficient fund managing plans for hospitals by looking into the management of medical fees for accident insurance. Car insurance, industrial accident insurance and seamen's insurance at a general hospital which is located in Busan during 29 months from January 1, 2009 to May 31, 2011 were assessed. The research data is the total number of 6,293 cases, including 2,251 car insurance cases, 2,350 industrial accident insurance cases, and 1,692 seamen's insurance cases. There were some significant differences found, as car insurance and seamen's insurance, including accident insurance, are types of insurance for which employers or traffic accidents offenders shall be the final premium payer. In addition, medical examination fees or premium payers are applied under their respective related laws. The findings suggest that it is necessary for managers of hospitals to prepare differentiated management schemes based on the characteristics of each insurer and schemes to ensure proper recovery strategies of uncollected medical account receivables.

• 융합정보논문지
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• 제12권2호
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• pp.184-191
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• 2022

본 연구는 자동차보험 이용환자들의 효율적 관리방안을 모색하는데 필요한 기초정보를 제공하고자 보건의료빅데이터개방시스템에 등록된 2016년부터 2020년까지 5개년 자동차보험 진료비 심사자료를 대상으로 분석하였다. 분석결과, 자동차보험 입원진료비 내역 구성비율 1순위는 상급종합병원은 처치 및 수술료, 종합병원·병원·의원은 입원료, 한방의료기관(한방병원, 한의원)은 처치 및 수술료, 치과병원은 처치 및 수술료 이었다. 외래진료비 내역 구성비율 1순위는 양방의료기관(상급종합병원, 종합병원, 병원, 의원)은 진찰료, 한방의료기관(한방병원, 한의원)과 치과의료기관(치과병원, 치과의원)은 처치 및 수술료 이었다. 자동차보험 입원 건당 진료비에는 투약료, 마취료, 특수장비 비율이 영향요인이었으며, 외래 건당 진료비에는 이학요법료 비율이 영향요인으로 확인되었다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4577-4581
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• 2015

Background: To explore the hospitalizations of breast cancer patients undergoing mastectomy, and to provide a basis for management, clinical prevention and treatment. Materials and Methods: We conducted an investigation by means of the retrospective survey and the medical records retrieval system, and made out the data of patients suffered from breast cancer in a hospital in Guangzhou from 2004 to 2013, including age, medical payment methods, pathological type, treatment, treatment results, complications, hospitalization days, cost and so on. Results: The average age of the inpatients was 50.14 years old. The main histologic types were infiltrating duct carcinoma (88.06%). The main surgery was modified radical mastectomy (80.41%). The cure rate was 90.80% during the 10 years. The main medical payment method was self-paying (57.28%). The average hospital stay was 13.51 days, and average hospitalization cost was RMB 23,083.66 yuan, proportion of drug fees up to 39.70%. Postoperative complication rate was 0.79%. The self-paying group was with the highest proportion of drug fees (P<0.05), while the free medical service group was with the longest hospitalization days (P<0.05). Conclusions: The payment methods significantly affected the proportion of drug fees and hospitalization days. The therapeutic effect was satisfactory with less complications and reasonable proportion of drug fees in our hospital.

• 한국직업건강간호학회지
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• 제17권1호
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• pp.86-95
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• 2008

Purpose: The objectives for this study are to produce the comprehensive management indexes and find their application strategies for appropriate medical care in primary care clinics under workers' compensation insurance. Method: Data of this study was workers' compensation insurance medical fees claim's data from July 2006 to June 2007. Data were analyzed using SAS 9.1 version by applying descriptive statistics and Pearson's correlation. The indexes such as costliness index(CI), standard medical fee were calculated based on the fourth revision of korean classification of diseases(KCD-4.). Results: The CI, visiting index(VI), outliers index(OI), and medical review adjustment percentage were positively correlated in the both inpatient and outpatient medical fees in primary care clinics under workers' compensation insurance. The major medical specialities were neurological surgery, general medicine, general surgery, rehabitational medicine, and orthopedic surgery. The CIs were slightly high in rehabitational medicine among major medical specialities. The CIs were mostly high in diagnosis, test, anesthesia, and rehabitational assistive device fees among major medical specialities. The CIs were slightly high in Kwangju, Daegu, Daejeon, and Busan districts among district management centers of Korea Workers' Compensation and Welfare Service. Conclusions: We suggest the continuous development of appropriate disease classification system and medical care quality indicators to successfully take root the comprehensive management for appropriate medical care under workers' compensation.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.95-97
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• 2011

Purpose: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we could improve the financial balance of the trauma center. Methods: Retrospective analysis was performed on patients visiting SNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. Results:The 31 patients in this study included 20 males and 11 females. The average ISS was $33.23{\pm}16.65$ points. We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The average hospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. Conclusion: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.

• 보건의료산업학회지
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• 제1권1호
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• pp.125-137
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• 2007

The current hospital industry is showing relatively low profitability in comparison with other industries due to the low medical fees and high costs. Therefore, our government presented the direction of improvement through model execution and support of the specialized hospitals. However, it is estimated that the specialized hospitals also will show differentiated management performances in accordance with their specialized fields due to the characteristics of medical treatment. Therefore, this study had attempted an analysis on the financial index in accordance with the weight of medical treatment items for the rehabilitative medicine department among the whole hospital groups through getting out of analyzing financial indices of individual hospitals centered at their costs. For this p개pose, this study had carried out its research by partially reciting the study on the plan for utilizing participations of private health resources to expand rehabilitative medicine services into the private people of the Korea Health Industry Development Institute(KHIDI). As its results, it was shown that the stability, profitability, activity and productivity of hospitals with high weight of medical treatment for the rehabilitative medicine department were lower than those for the general hospitals. To support smooth operations of these hospitals 'with high weight of medical treatment for the rehabilitative medicine department or of specialized rehabilitation hospitals, it is judged that the plan such as the support for hospital management fund and the additional recognition on the rehabilitative fees, etc. together with the actualization of medical fees must be provided for the institutions which are providing rehabilitative medical services more than the fixed percentage and being equipped with the sufficient medical equipment and personnel to do them.