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KMID : 0387320170270010030
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Korean Journal of Health Policy and Administration
2017 Volume.27 No. 1 p.30 ~ p.38
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Changes in Providers’ Behavior after the Reviewer Unification of Auto Insurance Medical Benefit Claims
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Kim Jae-Sun
Suh Won-Sik
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Abstract
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Background: This study aims to analyze the behavioral changes of healthcare providers and influencing factors after the reviewer unification of auto insurance medical benefit claims by an independent review agency.
Methods: The comparison data were collected from the second half of 2013 and the same period of 2014. The key indicators are the number of admission days, the number of outpatient visits, inpatient ratio, inpatient medical expenses, and outpatient medical ex penses.
Results: Four indicators (number of admission days, number of outpatient visits, inpatient ratio, and outpatient medical expenses) showed statistically significant drops, while one indicator (inpatient medical expenses) showed no significant change.
Conclusion: The reviewer unification of auto insurance medical benefit claims by an independent review agency showed significant reduction in cost and patient days.
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KEYWORD
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Auto insurance, Medical claims review, Unification of review process, Providers
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