The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer batic materials to the medical insurance inspection and the education of medical insur5ance.
The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan.
The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation.
The data were collected using patients charts and bills.
@ES The results of the paper analysis were as follows.
@EN 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee.
2. Decreasing order of operation fee adjustment were digestive (22.4%) muscular (22%) and neuro system operation (21.4%). Majority of the medication fee adjustments were injection form of medication (95.7%). 50% of the treatment fee adjustments
were
composed of injection fee (27.9%) and dressing or post-operative dressing fee (22.%). 74.7% of material costs were composed of oxygen (30.6%). Blood and the blood composed materials (44.1%).
3. Pre-discharge inspectipon showed 6% adjustment rate, .43% addition and 2.1% curtailment rate. Most of the adjustment were omission (66.1%).
4. Omission were divided by event omission (92.6%) and application mistake (7.4%). The decreasing order of omission fee were operation (21.84%), treatment (18.71%) diagnosis (18.68%), medication (14.53%) and material costs (10.84%). So operation
and
treatment part were the major part of the total onission fee (40.55%).
5. The average omission of diagnosis were 1,800 per month.
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