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KMID : 1170320180240030027
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Korean Journal of Health Economics and Policy
2018 Volume.24 No. 3 p.27 ~ p.47
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Design and validation of a four-party model of medical care through stepwise analysis of group behavior change -Comparison of Case Payment System and Service Payment System-
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Kim Min-Su
Kim Sang-Young
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Abstract
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Case payment system is a payment system in which a patient is charged with a fixed fee according to the kind of disease that the patient is hospitalized for. In korea, the case payment system went through since the February of 1997, and now it is applied to seven disease groups. In addition, a new case payment system is ongoing in public hospitals.
In the healthcare market, there exists the hospitals(supplier) and people(consumers), but also exists insurance companies that cover most of the healthcare expense and the government which transforms the structure of the market by implementing policies and regulations. Therefore, only by considering the behavior of the four parties can the right equilibrium be deducted.
This paper, to analyze the changes due to introduction of the case payment system, we predict the behavior change of 4 groups according to the quality of medical care, for to construct a logical structure. And then each deducted optimal by gradually altering behaviour of each party, so that the change of benefit structure of insurance company was deducted, considering effects of all four parties. Also, based on the empirical data set of appendicitis, a popular disease, case analysis was conducted to test the validity of the model.
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KEYWORD
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DRG, Case payment system, Service payment system, medical fee, four-party model
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