비급여를 포함한 상병‧수술별 환자부담 진료비 추정 연구 : 경피적 대동맥판 삽입술(TAVI) 사례

Abstract

It is very difficult to predict in advance the costs that patients pay for receiving medical services. The absence of useful information for patients, such as medical costs and safety, is causing various problems from a policy and economic perspective. Accordingly, in order for patients to use reasonable medical services at an appropriate cost, it is important to calculate and provide the total medical costs incurred per disease or surgery using comprehensive information that can be provided. Therefore, through the case of Transcatheter Aortic Valve Implantation(TAVI), which is burdensome for patients with severe aortic valve stenosis, the total medical costs and composition status including non-benefits medical costs were analyzed. First, the criteria and grounds for selecting disease and surgery to be analyzed were reviewed, and episode of care were defined. Second, the average medical costs including insurer's contributions, co-payments, non-benefits, and the composition of medical treatment items were analyzed. In addition, a comparison was presented between the total medical costs considering age group and comorbidities and the similar surgeries. This study used actual medical data to define episode of care and estimate total medical costs, to provide basic data for the composition of total medical costs, including non-benefits medical costs. In the future, there is a need for additional analysis to establish sufficient basis for the definition of episode of care and data sources, and to expand the target.