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KMID : 0861120100140010077
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Korean Journal of Oriental Preventive Medicine
2010 Volume.14 No. 1 p.77 ~ p.96
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Designing a Global Budget Payment System for Oriental Medical Services in the National Health Insurance
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Kim Jin-Hyun
Kim Eun-Hye
Kim Youn-Hee
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Abstract
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Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance.
Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries’ global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget.
Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure
Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.
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KEYWORD
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Prospective payment, Oriental medicine, Global budget Health insurance
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