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한국형 진단명기준환자군의 개발과 평가: 입원환자의 의료서비스 이용을 중심으로
신영수,이영성,박하영,염용권,Shin, Young-Soo,Lee, Young-Seong,Park, Ha-Young,Yeom, Yong-Kwon 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.2
With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U.S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U.S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the differences in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated fur its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed and payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U.S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.
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신경환(Kyung Hwan Shin),신현수(Hyun Soo Shin),표홍렬(Hong Ryull Pyo),이규찬(Kyu Chan Lee),이윤래(Yoon Tae Lee),명희봉(Hee Bong Myoung),염용권(Yong Kwon Yeom) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2
목 적 : 치료방사선과 의료서비스에 투입된 자원을 토대로 의료서비스별 원가를 산정하여 적절한 수가수준을 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 현행 ‘의료보험요양급여기준 및 진료수가기준(95년 12월판)’을 검토후 적절치 못한 수가항목을 재조정하고 이를 토대로 원가조사표를 개발한 후 40개병원을 대상으로 조사를 실시하여 의뢰하여 적절한 자료가 수집된 24개 병원의 자료를 분석하였다. 원가자료는 1995년도 1년간 발생한 비용자료로서 의료서비스별 원가를 산출후 의료장비의 가동률에 근거한 조정원가를 계산하였다. 현행 보험수가와의 비교를 위하여 3차병원 가산율 30%를 적용한 후 이를 본연구 결과로 산출된 조정원가와 비교하였다. 결 과 : 의료서비스별 추정원가 및 조정원가를 산출한 후 이를 현행 보험수가와 비교한 결과 방사선치료계획의 경우 5.05배-6.58배, 차폐물제작은 2.22배, 체외조사는 1.57배-2.86배, 강내치료 및 조직내치료는 3.82배-5.01배, 전신조사는 1.12배-2.55배씩 조정원가에 비하여 현행 보험수가가 낮은 가격을 보이는 것으로 나타났다. 또한 현행 진료수가기준의 진료행위 분류체계는 각진료행위의 원가를 적절히 반영하기에는 부적절하다고 판단되며 전신조사의 경우 적절한 재분류시 약 5배의 수가 차이를 보이는 것으로 생각된다. 결 론 : 치료방사선과의 현행 의료보험수가제도에서의 문제점은 보험수가의 수준이 낮다는 점과 진료행위 분류체계가 부적절하게 되어있다는 점이다. 향후 수가 책정시 이러한 문제점이 적절히 반영, 해결되도록 하여야 할 것으로 판단된다. Purpose : The main purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. Material and Methods : A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current payment rates of individual services. Results : The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12- 2.55 times lower in total body irradiation. Conclusion : We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.
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