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KMID : 1022120180200030027
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Health and Welfare
2018 Volume.20 No. 3 p.27 ~ p.48
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The Causes that Affect to Adjustment and the Recovery Rate of Medical Insurance Cost on the Medical Institution
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Yang Yu-Jeong
Yu Eun-Yeong
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Abstract
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This study investigated the factors affecting the health insurance adjustment rate and formal objection recovery rate, which are important considerations in the administration of medical institutions after the implementation of the National Health Insurance Program. It also attempted to identify the influences on these rates using adjustment awareness and work environment as mediators. A questionnaire survey was conducted among health care workers. Results were as follows. The inpatient adjustment rate was found to be higher when the number of beds was low, the number of reviewers was high, and the adjustment awareness was higher. The outpatient adjustment rate was found to be higher when number of beds was low, the number of reviewers was high, the adjustment awareness was high, and the work collaboration environment was rated poor. The formal objection recovery rate for hospitalizations was found to be higher when the number of beds was low, the number of reviewers was high, and the adjustment awareness was high. The formal objection recovery rate for outpatient treatment was found to be higher when the number of beds was low, the number of reviewers was high, and the work collaboration environment was rated poor. The present study aimed to contribute to the rational management of medical institutions by proposing the reduction of the adjustment rate of insurance benefits by health insurance and the increase in the formal objection recovery rate.
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KEYWORD
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Adjustment rate, Formal objection recovery rate, Adjustment awareness, Work collaboration environment, Medical institution information
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