KMID : 0614720220650120841
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Journal of Korean Medical Association 2022 Volume.65 No. 12 p.841 ~ p.849
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Physicians¡¯ perception of the reform of the review and assessment system of national health insurance reimbursement claims
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Lee Jung-Chan
Kim Kye-Hyun
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Abstract
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Background: The Korean government has been promoting the reform of the review and assessment system of national health insurance reimbursement claims. The aim of this study was to find out physicians¡¯ perception and evaluation of the health insurance review and assessment system and present the direction for the government¡¯ reform plan.
Methods: The 2020 Korean Physician Survey questionnaire was sent to 57,714 members of the Korean Medical Association from November 19, 2020 to January 10, 2021. A total of 6,507 physicians (11.5%) responded; of these, the responses of 4,454, including the self-employed and employed, professors, and fellows, were included for analysis. The respondents¡¯ perception of the current health insurance review system and of the government¡¯ reform plan were analyzed.
Results: It was found that 84.2% of the respondents evaluated the current health insurance review system negatively.particularly in terms of medical autonomy, transparency of the review standards, the standard development and application process, and the post-review adjustment process. Furthermore, only 0.7% of the respondents evaluated the government¡¯s reform plan positively.particularly, the utilization of clinical practice guidelines for review standards, introduction of the professional review committee, and expansion of the link between the review and assessment system.
Conclusion: Policymakers should understand physicians¡¯ perception and evaluation of the health insurance review system. In addition, the reform plan should be thoroughly communicated to physicians.
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KEYWORD
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Health insurance, Health insurance reimbursement, Physicians, Healthcare policy, Republic of Korea
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