국내 바이러스 검사 건강보험 행위 등재 및 수행 현황
Current Status of National Health Insurance Service on Viral Tests in Korea
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배경: 바이러스를 신속하고 정확하게 진단하는 것은 중요하다. 국내 진단검사의학과 검사실에서 실시되지 않는 바이러스 검사 항목중 국외에서 검사되거나 질병관리청에서 검사할 수 있는 항목에대한 현황을 조사하여 바이러스 검사에 대한 국내 건강보험요양급여비용 행위 등재 도입의 계기와 근거를 마련하고자 하였다. 방법: 바이러스 검사 건강보험 행위 등재 현황에 대해서는 건강보험요양급여비용과 미국의 Current Procedural Terminology (CPT) 를 참고하여 정리하였다. 국내 검체검사전문수탁기관을 통한 국외재위탁 바이러스 검사 현황은 국내 주요 5개 검체검사전문수탁기관의 10년간(2013–2022년)의 해외 위탁 검사 자료를 분석하였다. 질병관리청에서 검사하고 있는 항목과 진단검사 방법은 질병관리청에서 발간한 감염병 신고 현황 연보와 법정감염병 진단검사 통합 지침을 참고하였다. 결과: 건강보험 행위 급여·비급여 목록표의 바이러스 검사 하부에는 검사원리별로 특수배양, 일반면역검사, 정밀면역검사, 면역형광법, 중화시험, 웨스턴블롯으로 분류된다. 분자검사법에 해당하는항목은 검사원리별로 핵산증폭, 핵산교잡, 염기서열분석을 포함한다. 미국 CPT 코드집은 미생물 검사 방법하에 바이러스 검사가 포함되어 있다. 국내 주요 검체검사전문수탁기관에서 해외 검사기관으로 의뢰한 검사와 질병관리청에 의뢰된 다빈도 바이러스 검사결과를 토대로 수가 신설이 제안된 검사 항목은 홍역 분자검사법, A형 간염, 일본뇌염, 아데노바이러스 및 엔테로바이러스 형(type) 에 대한 분자검사법과 뎅기바이러스 감염증 항원검사였다. 결론: 국내 바이러스 검사 건강보험 행위 등재 및 수행 현황 자료와 제안이 바이러스에 의한 감염 진단 및 관리에 도움이 되기를 바란다.
Abstract
Background: Rapid and accurate diagnosis of viruses is important. In this study, we investigated the current status of viral tests that could be performed overseas or by the Korea Centers for Disease Control and Prevention (KCDC) to provide a basis for the introduction of viral tests into the Korean health insurance service. Methods: We summarized the current status of the health insurance service for viral tests by referring to the national health insurance allowance of medical care and the Current Procedural Terminology (CPT) in the USA. We analyzed the status of viral tests performed overseas from the 10-year (2013–2022) data of five major Korean referral laboratories. The items tested by KCDC were based on the annual reports and the integrated guidelines for diagnostic testing published by KCDC. Results: According to the viral tests in the health insurance service, special cultures, immunological, immunofluorescence, and western blotbased tests could be listed. The molecular tests included nucleic acid amplification and hybridization as well as sequencing. In the CPT coding system, the viral tests were included under each microbiological test method. Based on the high-frequency virus tests performed overseas and by KCDC, the proposed tests included molecular assays for measles, hepatitis A, Japanese encephalitis, adenoviruses, and enterovirus types as well as antigen tests for dengue virus infection. Conclusions: The hereby presented data and suggestions on the current status of health insurance service of virus testing in Korea would be potentially helpful in viral infection diagnosis and management.
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