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KMID : 1235020120060040025
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Health Service Management Review
2012 Volume.6 No. 4 p.25 ~ p.35
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Study on the unification theory of added-ratio by size of medical institution between National Insurance and Traffic Accident Insurance
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Kim Jung-Duck
Jeong Eun-Wook
Lee Jong-Hoon
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Abstract
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Government has driven the unification of added-ratio by size of medical institution(below ``added-ratio``) between National Health Insurance(NHI) and Traffic Accident Insurance(TAI). And Some studies have supported the policy through arguing that length of stay(LOS) and medical expenditure per hospitalization care of TAI is longer or higher than that of NHI. There is added-ratio difference in tertiary hospital(TAI 15%p higher than NHI), general hospital(TAI 12%p higher than NHI) among medical institutions between NHI and TAI(below ``group A``). But there is no difference in hospital(TAI 1%p higher than NHI), clinic(TAI=NHI)(below ``group B``). The policy target for the unification of added-ratio is group A. But LOS and medical expenditure per hospitalization care(MEPC) of group A is very short in realty. And management strategy of group A is not MEPC but medical expenditure per day(MEPD). To compare 3 medical institutions(general hospital, hospital, clinic) with LOS and MEPC according to same ICD code between NHI`s inpatients and TAI`s inpatients. 3 general hospitals, 3 hospitals, 3 clinics. Treatment amount of 6 months for each medical institutions. TAI`s LOS and MEPC of General hospital is shorter than that of NHI. But THI`s LOS and MEPC of hospital and clinic is longer than that of NHI. TAI`s LOS and MEPC of Group A is shorter than that of NHI. But TAI`s LOS and MEPC of group B is longer than that of NHI.
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KEYWORD
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unification, added-ratio, medical institution, National Health Insurance, Traffic Accident Insurance
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