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KMID : 1154920210160010064
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Korean Journal of Insurance Medicine
2021 Volume.16 No. 1 p.64 ~ p.82
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A study on the change of Korean health insurance reimbursement fee and insurance policy direction in anesthesia
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Park Seo-Young
Yon Jun-Heum
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Abstract
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Background: Since the National Health Insurance System was introduced to provide patient safety and high-quality care, the level of healthcare coverage of the health insurance has been gradually increasing as a result of an increased number of medical service items and a rise in the price of each item.
Methods: In this study, the classification and reimbursement fee changes of health insurance medical service items related to anesthesia from 2005 to 2020 were collected. Based on this, the background and reason for the classification and reimbursement fee changes were investigated. To calculate the annual growth rate of anesthesia, the number of health insurance for each activity was multiplied by the frequency of claims and a weighted average was assigned.
Results: During the evaluated period, the relative value units of the anesthesia fee increased. As the unit price per point increased, the total number of health insurance for total anesthesia fee increased. In addition, the average annual growth rate of anesthesia cost in medical insurance among secondary hospitals was 6.1% from 2005 to 2016.
Conclusions: The development of compensation is chiefly reviewed in combined spinal-epidural (CSE) anesthesia, monitored anesthesia care (MAC) and fee of post-anesthesia care (FPC). Changes in the fee to call outside-facility anesthesiologists and the incentive system for special cases are also reviewed. In addition, a policy to improve reimbursement in anesthesiology is proposed.
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KEYWORD
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Health insurance reimbursement, Insurance, Relative value scale
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