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KMID : 0603920170250040001
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Journal of Korean Academy of Occupational Therapy
2017 Volume.25 No. 4 p.1 ~ p.17
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Analysis of Medical Rehabilitation’s Fee Using National Health Insurance Service’s Big Data : Focusing on ICF Model
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Cha Yu-Jin
Song Young-Jin
Kim Eun-Young
Kim Sun-Jung
Kim Dong-Jun
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Abstract
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Objective: The aim of this study is to investigate how the national health insurance’s fees for services reasonably pay for the International Classification of Functioning, Disability and Health(ICF).
Methods: We used data from the national health insurance service’s national sample cohort 2002?2013, which is sample of one-million people representing the entire population of health insurance beneficiaries, including medical aids. We analyzed claims for section 3: the professional rehabilitation fee under the national health insurance's fee schedule.
Results: South Korea's rehabilitation fee schedule does not reflect the notion of the ICF's health and rehabilitation, which ultimately seek improving quality of life through independent living, activity/participation, and a return to society. In addition, we also found that a rehabilitation delivery system of acute-subacute(recovery)-chronic phase for efficient rehabilitation services considered base on a patient’s disease and severity has not been established in this country.
Conclusion: To provide efficient and effective rehabilitation services, a rehabilitation delivery system of the acute-subacute(recovery)-chronic phase should be reformed, and the role of healthcare institutions based on a classification is also needed. Finally, for improvement and the inauguration of guideline for assessment and review, an optimum fee schedule regarding rehabilitation services should also be introduced.
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KEYWORD
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Activities and participation, Big-data, Body function, ICF, Professional rehabilitation services, Rehabilitation system, Rehabilitation to society
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