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KMID : 0387320220320020125
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Korean Journal of Health Policy and Administration
2022 Volume.32 No. 2 p.125 ~ p.136
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Medicare’s Reimbursement for Innovative Technologies: Focusing on Artificial Intelligence Medical Devices
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Lee Bo-Ram
Yim Jae-Jun
Yang Jane-Mi
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Abstract
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The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management ofappropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actualmedical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate theCI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classificationsystem of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate theadmission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In someepisodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in totalcost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patientunit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in totalmedical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary toinpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means thatprevious CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classificationsystem which can be used as a more effective CI indicator is needed.
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KEYWORD
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Artificial intelligence, Medical device, Medicare, Reimbursement
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