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KMID : 0387320090190030109
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Korean Journal of Health Policy and Administration
2009 Volume.19 No. 3 p.109 ~ p.124
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An Empirical Study on General Deterrence Effects of the On-site Investigation System in the Korean National Health Insurance
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Kang Hee-Chung
Hong Jae-Seok
Kim Se-Ra
Choi Ji-Sook
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Abstract
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Background: This study aimed to examine whether cases of punishing false claimants threat general physicians to check their medical cost claims with care to avoid being suspected, and identify empirically general deterrence effects of the on-site investigation system in the Korean National Health Insurance.
Methods: 800 clinics were selected among a total of 15,443 clinics that had no experience of on-site investigation until June 2007 using a stratified proportional systematic sampling method. We conducted logistic multiple regression to examine the association between factors related to provider’s perception of on-site investigation and high level of perceived deterrence referring to fear of punishment after adjusting provider’s service experiences and general characteristics.
Results: The probability of high perceived deterrence was higher 1.7 times (CI: 1.13-2.56), 2.73 times (CI: 1.68-4.45) each among clinics exchanging the information once or more per year or once or more for 2-3 months than among clinics no exchanging the information about on-site investigation. Also, the probability of high perceived deterrence was higher 2.27 times (CI: 1.28-4.45) among clinics that knows more than 3 health care institutions having experienced an on-site investigation than among clinics knowing no case.
Conclusion: A clinic knowing more punishment cases by onsite investigation and exchanging more frequently information about on-site investigation is likely to present high perceived deterrence. This result wil1 provide important information to enlarge preventive effects of on-site investigation on fraud and abuse claims.
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KEYWORD
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on-site investigation, punishment, general deterrence
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