• 한국병원경영학회지
• /
• 제23권4호
• /
• pp.15-25
• /
• 2018

Purposes: The objectives of this study present the direction of the criteria for the separately reimbursement of therapeutic medical device. Methodology: We summarized experts' opinion using Delphi survey and Analytic Hierarchy Process(AHP). 48 experts were gathered from Medical Insurance Review Nurses Association, medical device industry, academy and association, Medical Device Expert Evaluation Committee. Descriptive statistics, consistency index, content validity ratio were analyzed. Findings: Clinical utility, patient safety, infection control, cost-homogeneity, cost-effectiveness showed high feasibility and importance, but market contribution and functional utility showed low feasibility and importance in a relative sense. The results of functional utility differed between clinical and non-clinical experts. Measurability was low across the whole area. Among the criteria for the separately reimbursement of therapeutic medical device. Patient safety/infection control and clinical utility showed the highest relative importance values, analyzed using AHP. Practical Implications: Patient safety and infection control are needed to be considered as one of Value Assessment Criteria. It is important to find out how to improve the measurability of therapeutic medical device.

• 한국도서관정보학회지
• /
• 제39권2호
• /
• pp.65-83
• /
• 2008

국립중앙도서관은 2007년 "온라인디지털자료 납본 및 이용에 관한 법률(안)"을 제정하여 시행을 준비하고 있다. 본 연구의 목적은 이 법률(안)의 시행에 앞서 납본 보상금의 산정기준을 제시해 보고자 하는 것이다. 본 연구를 위하여 주요 국가의 디지털자료 납본 현황이 조사되었고, 디지털자료 납본의 주요 이해당사자인 전자책, 음악저작권 관련 단체의 의견이 수렴되었다. 마지막으로 본 연구에서는 디지털자료의 납본에 따른 보상금 산정기준을 제안하였다.

• 성인간호학회지
• /
• 제24권4호
• /
• pp.358-369
• /
• 2012

Purpose: This study was performed to compare the costs of nursing interventions implemented for the obstetrical and gynecological patients using Korean Reimbursement System and ABC codes system developed in the US for costing out interventions performed by health care professional. Methods: First, the narrative data on nursing interventions were extracted from electronic medical record system of a tertiary university and mapped with Nursing Intervention Classification (NIC) by two researchers until 100% consent was reached. Narrative nursing interventions mapped with NIC were then remapped with ABC codes system using the electronic program developed in the research. The mapping data were analyzed with real numbers, frequency, percentage, mean, and standard deviation. Results: More nursing interventions were mapped with ABC codes than Korean reimbursement system. Total of 97 different types of narrative interventions could be mapped with NIC, 43 NIC interventions could be reimbursed by ABC code but only 16 NIC interventions were reimbursed by Korea Reimbursement System. Conclusion: Korean medical insurance fee system needs amendment to include more comprehensively interventions performed by nurses which are very important to patient outcomes. Further study is needed to develop strategies to costing out nursing interventions.

• 보건행정학회지
• /
• 제15권4호
• /
• pp.1-25
• /
• 2005

Legislation on pharmaceutical reimbursement decision using economic evaluation results was made in Korea in fm, but has yet to be fully implemented. We evaluated the quality of Korean economic evaluation studies of pharmaceuticals to understand gaps between legislation and implementation. From this evaluation, we propose policy options that might strengthen the research Infrastructure In order to support such studies. We reviewed 23 published studies for drugs conducted between 1996 and 2004. Evaluation criteria included methodological characteristics, healthcare system characteristics, population characteristics, and applicability of results. Large variation in study quality was observed, particularly with study design, outcome data, treatment patterns and interpretation. Korean clinical data used was mostly from observational studies of 1-2 hospitals. Foreign data was extracted from clinical trials that did not Include Asian population and their selection criterion was not clarified. With respect to treatment patterns, medical records and hospital bills were used without adjustment regarding area, hospital type, and others. And next frequent situation relied on expert opinion from academic physicians in specialty practice. preference measures, when used, were not elicited from the Korean population. $78.3\%$ of studies did not clarify the funding source. If the Korean economic evaluation policy is to provide meaningful data for decision makers, the quality of cost-effectiveness studies will need to improve dramatically. This may involve access to or creation of better data, more diverse funding, unproved training of researchers and evaluators, and partnerships with technology manufacturers.

• 대한치과의사협회지
• /
• 제48권6호
• /
• pp.459-468
• /
• 2010

International Classification of Disease (ICD-10) is widely used as a crucial reference not only in the medical diagnosis of diseases but also within the health insurance system. It makes possible for medical personnel to make decisions systematically and for the people working in the health insurance or public health industries to better understand medical issues. However, this classification is often not enough or acceptable in a clinical setting. Many countries amend in their own way to make it more appropriate for their people. Korean Classification of Disease (KCD-5) was made by adding a 5 digit code for some diseases to clarify the conditions of the patients. The authors found problems of KCD-5 in temporomandibular disorders and several related medical problems. Medical treatment for these problems had not been covered even by public health insurance until 2000 in Korea. For the last decade, private insurance companies have introduced new items for reimbursement of the treatment fees the patients actually pay. The authors assumed that many patients with these medical problems encountered difficulties in the reimbursement from private insurance companies because KCD-5 did not classify these medical conditions appropriately. An overview of KCD-5 and suggestions for improvement are introduced in this study.

• 중환자간호학회지
• /
• 제11권3호
• /
• pp.95-107
• /
• 2018

Purpose : This study aimed to investigate the public's perception of reimbursement for the education and counseling services provided to advanced practice nurses in intensive care units. Method : This was a secondary data analysis study. The original data were collected utilizing an online panel. The sample comprised 615 individuals aged between 19 and 49 years nationwide. The study variables included the public's perception of reimbursement for education and counseling services, age, gender, education level, income, and health status. Variables such as past experience of being admitted to an intensive care unit by self, family, or relatives and the recognition of advanced practice nurses were also examined. Results : The mean of the perception score was 3.15 on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). Among the participants, 89.2% answered "somewhat agreed" or "strongly agreed" to the question about the education and counseling services being covered by the National Health Insurance. Moreover, education level, past experience of being admitted to an intensive care unit by self, family, or relatives, and recognition of advanced practice nurses were significantly associated with the perception score. Conclusion : Efforts should be made to publicize the need for the education and counseling services that are provided to advanced practice nurses in intensive care units.

• Journal of health informatics and statistics
• /
• 제43권4호
• /
• pp.318-328
• /
• 2018

Objectives: People are living longer, but often with diseases or chronic conditions. As a consequence, interest in resolving insurance blind spots is growing. This study provides substandard risk-relevant statistics to help substandard risks who are likely to fall in insurance blind spots obtain insurance coverage, such as the reimbursement of medical costs, as well as to stimulate insurance product development. Methods: This study uses National Health Insurance Service (NHIS) cohort data to determine the relevant statistics. The incidence rates of severe diseases are derived and compared against standard risks to establish a set of relative risk factors. These incidence rates of standard and substandard risks are then compared. Results: Currently, an individual's cancer history is used in the underwriting process for simplified issue insurance. However, underwriting focusing on hospitalization and procedures related to serious illnesses could lower premiums for substandard risks. Moreover, the statistical results could be used to expand the coverage of health insurance products. Conclusions: This study's relative risk factors can be used to derive simplified issue premium rates for substandard risks. They can also be used to implement discount and loading schemes for medical reimbursement insurance and help insurance companies implement proactive risk management.

• 한국임상약학회지
• /
• 제31권1호
• /
• pp.1-11
• /
• 2021

Objective: This study aimed to overview and assess the effectiveness of the policies and regulations that have governed new drug access in Korea, and to propose policies to enhance patient access to drugs, particularly for new innovative medicines. Methods: We approached drug access issues in two perspectives: approval lag (or availability) and reimbursement lag (or affordability). The issues were identified and evaluated through the review of literature, public documents, reports published by the government agencies and private organizations, and news articles. Results: To shorten approval lag, it is recommended to hire and train more reviewers at the Ministry of Food and Drug Safety. Increasing user fees to a realistic level can facilitate this process. To reduce reimbursement lag, flexible incremental cost-effectiveness ratio threshold, alternative cost-effectiveness evaluation, and establishment of funding source other than the national health insurance are identified as the areas to be improved. Conclusion: The current policies and regulations had to be supplemented by new systems to drastically promote patient accessibility to new drugs, consequently in order to promote national public health.

• Clinics in Shoulder and Elbow
• /
• 제25권1호
• /
• pp.42-48
• /
• 2022

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

• 한국콘텐츠학회논문지
• /
• 제22권6호
• /
• pp.712-728
• /
• 2022

세계적으로 노인인구 급증으로 병용약물이 늘어나고, 의료기술의 발달에 따라 다양한 질병 상태의 해소를 위한 약물사용이 늘어나고 있어, 약물의 효과적이고 안전한 사용을 위해 약사의 전문지식에 대한 기대 및 요구는 점차 높아지고 있다. 이에 우리나라는 지난 2009년부터 기존 4년 교육이 아닌 6년제로 약학대학의 학제를 개편하였으며, 고도화된 약료서비스의 제공을 위해 준비된 전문인력을 배출하고 있다. 그러나 현행 국민건강보험 급여체계는 여전히 전통적 약사의 역할인 조제를 중심으로 산정되어, 약사가 제공하거나 제공 가능한 서비스와, 실제로 지급되는 보상급여 간 극심한 간극이 존재하고 있다. 이에 본 연구에서는 약료서비스 지불보상제도의 국제적 동향을 비교분석하여, 현행 한국의 지불보상체계에 시사점을 주고자 하였다. 한국과 일본, 영국 및 미국의 약사서비스 지불보상정책 및 관련 문헌을 검토한 결과, 일본, 영국 및 미국의 시스템은 환자중심의 약료서비스에 대해 제도적으로 구체적이고 다양한 지불수단을 마련하여 보상하고 있으나, 한국의 약국 서비스는 상대적으로 조제관련 행위만 보상하는 정도에 그치고 있어, 국내 약료서비스의 발전을 구조적으로 저해하는 결과를 낳고 있는 것으로 나타났다. 결론적으로, 안전한 약물사용을 위한 환자중심 약료서비스의 제공을 위해서는 국내 지불보상체계가 인정하는 약료서비스의 범위를 확대하고 관련 서비스의 종류를 다양화하여 국내 약사급여제도를 개선시켜나갈 필요가 있다.