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KMID : 0861120170210030001
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Korean Journal of Oriental Preventive Medicine
2017 Volume.21 No. 3 p.1 ~ p.10
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Survey on practice behavior and model acceptance of traditional Korean medicine(TKM) doctors in order to develop health insurance payment model related with TKM clinical practice guidelines(CPGs)
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Kim Dong-Su
Lim Byung-Mook
Han Dong-Woon
Park Ji-Eun
Jeong Hyoung-Sun
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Abstract
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Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs).
Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model.
Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients.
Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.
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KEYWORD
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Clinical practice guideline, Health insurance, Payment model, Traditional Korea medical doctor survey, Traditional Korean medicine
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