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환산지수계약 의료기관 유형분류를 위한 특성변수에 관한 연구

A Study on Characteristic of Optimal Medical Institution Classification for Conversion Factor Contract

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초록

Health insurance fees are set by relative value scales and conversion factor. Since 2008, conversion factors have been contracted separately with 7types of providers as the characteristics of providers are different. Therefore, it became one of the most important issues to find optimal medical institution classification in conversion factor contract. In this study, we investigate specific factors which affect the medical institution classification for conversion factor contract types. Using data from National Health Insurance Corporation, we analyzed the difference among several factors. When we classify the medical institution by service, size, location, and ownership, the result shows that there are statistically significant differences among these factors. It implies that the revenue and cost structure of medical institution are affected by these factors. This paper contributes to health insurance authorities in that they should consider these factors when they classify medical institution for conversion factor contract.

Abstract

Health insurance fees are set by relative value scales and conversion factor. Since 2008, conversion factors have been contracted separately with 7types of providers as the characteristics of providers are different. Therefore, it became one of the most important issues to find optimal medical institution classification in conversion factor contract. In this study, we investigate specific factors which affect the medical institution classification for conversion factor contract types. Using data from National Health Insurance Corporation, we analyzed the difference among several factors. When we classify the medical institution by service, size, location, and ownership, the result shows that there are statistically significant differences among these factors. It implies that the revenue and cost structure of medical institution are affected by these factors. This paper contributes to health insurance authorities in that they should consider these factors when they classify medical institution for conversion factor contract.

참고문헌 (11)

  1. 요양기관의 특성을 고려한 유형별 분류 방안, "국민건강보험공단", 국민건강보험공단, ~ (2006)
  2. 건강보험 수가제도 중장기 발전방안, "국민건강보험공단", 국민건강보험공단, ~ (2011)
  3. 2012년도 유형별 환산지수 연구, "국민건강보험공단", 국민건강보험공단, ~ (2011)
  4. 김진현, "건강보험 환산지수의 유형별 분류방안", 대한예방한의학회지, 10(2), pp.147~158 (2006)
  5. 2008년도 요양급여비용 계약을 위한 환산지수 연구, "대한의사협회", 대한의사협회, ~ (2007)
  6. 오동일, "우리나라 행위별 수가의 환산지수 연구 흐름", 산업과학연구, 12, pp.1~25 (2002)
  7. 오영숙, "건강보험 의료행위의 비용구조", 보건행정학회지, 20(2), pp.40~52 (2010), 한국보건행정학회
  8. 이평수, "요양급여비용 유형별 계약의 과제와 발전방향, 건강보험심사평가원", HIRA정책동향, 2(1), pp.16~19 (2008)
  9. 최병호, "건강보험심사평가원유형별 수가계약을 어떻게 볼 것인가? 앞으로의 진로는?", HIRA정책동향, 2(1), pp.6~10 (2008), 건강보험심사평가원
  10. 요양기관 그룹별 환산지수 계약방안 개발, "한국보건산업진흥원", 한국보건산업진흥원, ~ (2005)
  11. 2006년 요양급여비용 계약을 위한 환산지수 연구, "한국보건산업진흥원", 한국보건산업진흥원, ~ (2006)

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