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KMID : 0386819950050020035
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Journal of the Institute of Health Environmental Sciences
1995 Volume.5 No. 2 p.35 ~ p.48
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A Study on Updating the Rate of Health Insurance Fee Schedules in 1995
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문옥륜
장동민/이석구/강선희/박실비아/최상은
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Abstract
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Since the introduction of the National health Insurance Program as of 1977, the charges for medical treatment have been increased as much as by 15 times. In general, Fee schedules should be decided upon by taking account of the ability to pay for
medical services by consumers, and the financial status of both insurers and medical facilities.
As the policy maker have mainly concerned about controlling the price of medical service, the level of fee schedules has kept low: the accumulative index of the charge for charge for medical treatment showed only 89% as against the accumulative
consumer's price index during the last 18 years. This lower increasing rate has caused us many undesirable outcomes. For example, medical practices have been twisted to orient toward higher earning practices and high cost equipments have been
introduced
imprudently.
This study is to develop a new method of determining the adequate increasing rate for medical fee schedules. The data complied by KIHM were used such as 'Anlysis of the Hospital Management, 1992' and the 'Study on the Adjusted Increasing Rate for
the
Insurance Fee Schedules, 1994'.
The basic model of updating fee schedules has been developed to include deficit rates and the incentive for medical service quality improvement, and the final adjustment rate was derived form it accordingly.
If the authorities decide to increase fee schedules as of January1995, the adjustment by 12.59-14.63% will be enough and if it becomes June 1995, the rates will go up as much as by 21.58-25.08%.
Furthermore, this study shows that the government should regularize the period of increasing time and this will make medical facilities to predict their operational budgets possible.
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KEYWORD
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