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KMID : 0981820070270020143
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Korean Journal of Laboratory Medicine
2007 Volume.27 No. 2 p.143 ~ p.150
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Survey Results of Medical Insurance Reimbursement System for Independent Medical Laboratories in Korea
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Bae Sook-Young
Min Won-Ki
Lee Chang-Kyu
Cha Young-Joo
Kwon Jung-Ah
Kim Jang-Su
Yoon Soo-Young
Lee Kap-No
Kim Dae-Won
Chae Seok-Lae
Hwang Yoo-Sung
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Abstract
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Background : A questionnaire survey was performed to perceive the problem of the current medical insurance reimbursement system for laboratory tests referred to independent medical laboratories;then, we intended to find a way to improve the reimbursement system.
Methods : Questionnaires were distributed to 220 independent medical laboratories and 700 laboratory physicians from July through October 2005. Frequency analysis was used to analyse the replies from 109 respondents to 25 questionnaire items regarding the current medical insurance reimbursement system for referral tests, problems with the system, and suggestions for the improvement of the system.
Results : Among the 109 respondents to this survey, 49 (45.8%) considered the current reimbursement system to be unsatisfactory, while only 16 (15.0%) answered satisfactory. The problem was that the referral clinics-not the laboratories that performed the tests--would first receive their reimbursement for the laboratory tests from Health Insurance Review Agency (HIRA) and then give a portion of the laboratory test fees to the independent medical laboratories after the deduction of administrative fees. They (62.5% of the respondents) would prefer a separated reimbursement system by which the referral clinic-as well as the independent medical laboratory-would receive their reimbursement directly from HIRA through an Electronic Data Interchange (EDI) system. In this new system, 34% of the respondents expected the quality of the laboratory tests to be improved; however, 41.6% answered that the income of the referral clinic is expected to decrease.
Conclusions : For the improvement of the medical insurance reimbursement system, the administrative fee for the referral clinic and the test fee for the independent medical laboratory should be reimbursed directly to the respective organizations. These changes could be made possible with the proper analysis of medical costs and the development of an effective EDI reimbursement system. (Korean J Lab Med 2007;27:143-50)
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KEYWORD
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Medical insurance reimbursement system, Survey, Medical costs, Electronic data interchange system
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