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KMID : 0355420020260030283
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Journal of Korean Academy of Oral Health
2002 Volume.26 No. 3 p.283 ~ p.294
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An evaluation study in the adjusted insurance reimbursement review system of periodontal treatment
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권호근/Kwon, Ho-Keun
최연희/최충호/Choi, Youn-Hee/Choi, Chung-Ho
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Abstract
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The purpose of this study was to investigate awareness of dentists in the adjusted insurance reimbursement review system of periodontal treatment(AIRRSP) for evaluating a operation of this system after one year and to suggest the improvement system on periodontal related dental insurance claim. The results of this study were as followed:
1. In the participant motive of AIRRSP, the 73.3% answered that they wanted to treat for their own opinion, the 21.0% answered that they avoided disadvantage such as inspection, the 4.8% answered that they just followed other dentists, and the 0.9% answered that they were with no definite idea.
2. In the enforcement effect of AIRRSP, the 50.0%% answered that they can actively treat patients who need the periodontal treatment, the 68.6% answered that a frequency of periodontal treatment was virtually increased after operating this system, and. the 69.6% answered that the sliding scale of periodontal treatment was converted to prospective insurance coverage of periodontal treatment. Thus, they had positive opinion in the AIRRSP. However, the only 9.1% answered that self-regulating guidance and actual inspection were to be free.
3. In the general evaluation of AIRRSP, the 68.6% of participant group answered that they contributed positively on normalization of periodontal treatment and the 21. 3% answered in the non-participant group.
4. In the future, even though AIRRSP is to be continued same as at present, the opinion that anybody could join a member was 76.3% in the participant group, and 68.3% in the non-participant group. Most of their opinion was that improve more logically their present policy.
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5. In the analysis of the health insurance review agency, treatment fee payment status of both participant dental clinic and non-participant dental clinic in 1999 was that participant dentists had higher than nonparticipant dentists. Total requesting case was 742thousand case(38.2%), total treatment fee was 274billon7,400won(62.9%), each case of treatment fee was 4,019(17.9o%)won, total treatment fee was 6,421(79.9%)won.
In conclusion, we can consider that periodontal treatment in dental clinics was activated by the enforcement of AIRRSP. Furthermore, if AIRRSP is compliment through a positive publicity and a systematic improvement, it will be a desirable system for solving a distorted condition of public oral health promotion.
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