대전·충청지역 치과건강보험 요양급여비용 청구자의 인식도 분석조사

Abstract

Objectives : This research was organized to discover the awareness of problems and improvement ways of application system for recuperation allowance. Methods : Therefore 1,135 of questionnaires were organized to send to the demanders of dental clinic recuperation allowance in Daejun Metropolitan City and Southern & Northern Chungchung area, registered in Health Insurance Review & Assessment Service by May 2010. 207question naires of being very well answered were chosen to analyze. And there sults were derived like below. Results : 1. Most of the responders are engaged with Dental clinic centers. The proportions of receptionists, who have been worked for more than 5 years, are the most. And 10~50% of application were the most. 2. The awareness about the standard of fee for consultation and diagnosis were average. The negative awareness was relatively often generated from the health center which processes the invoice as pay per day system rather than dentists of university hospital where charge per treatment. Regarding positions, dentists were claimed to be inappropriate and there was a meaningful difference (p＜0.05). For the reason of awareness, most of the responds were represented to be negative as they claimed that the system was designed for convenience of dentists rather than for the patients by examining the objective judgments. 3. The examples of judgments should be opened to the public, according to the responders. Regarding the judgment control of insurance application, most of the answers were assorted to be into two groups; ‘Do not have enough information about judgment standard’and ‘error of disease, code and program’. Therefore the responders answered that they have ever been controlled by convenience of the medical centers so it generated the meaningful difference (p＜0.05)4. About solutions after judgment control, ‘knowing the reason of judgment control from the acquaintances of Health Insurance Review & Assessment Service then reflect’was the highest. The dental clinics of University Hospital and private dentists were shown to be them ostactive participant of this system. Concerning of the posi-tion, agents of application are shown to be the active participants for objection application process. There was also a meaningful difference(p＜0.05) 5. The reason for not claiming objection was indicated that the awkwardness or inconvenience of communication with Health Insurance Review & Assessment Service was 20.9%. Therefore it is analyzed to demand the diversity of communication methods between Health Insurance Review &Assessment Service and clinic centers and shift to the clinic center. But it was hard to find the meaningful difference so far. 6. About the awareness of improvement for correcting errors, generated from insurance application process, priorities were sorted out to be improvement of application program setting, accurate charting of diseases and treatments. The awareness of Dental clinics of University hospital and private dentist were the highest whereas the health center was relatively low. It generated the meaningful difference (p＜0.05). About the opinion of the professional employees for insurance application and its judgment, dental clinics of university hospital and private dentists were the highest, dentists were the lowest regarding the positions. 7. Positive responds were the most egarding the awareness about reading the treatment details and charges. However, 50% of dentists opposed to this, therefore it was shown a noticeable difference from other groups. It also generated a meaningful difference. (p＜0.05)Conclusions : When national Health Insurance Review Agency and dentistry medical treatment organization cooperated each other, successful factors of the adjustment variables which were derived if a synthesis tried the above-mentioned result of research were thought to realizable things.