합리적인 수가 산정을 위한 최적화 기반 수가 행위(시술, 진료) 시간 추정 방법 = Mathematical Programming Approach to Estimation of Medical Treatment Time for Fee-for-service Cost

다국어 초록 (Multilingual Abstract)

This study aims to scientifically improve the self-recording method of the questionnaire, which is the most important method for calculating medical cost-based fees. This study addresses the increasing demand for an improved payment system and refined relative value scales, as the financial sustainability of Korea’s fee-for-service (FFS) health insurance system faces growing challenges. Recognizing the critical role of service time estimates (an essential cost allocation criterion for medical expenses) in establishing a cost-based fee schedule, this research employs a mathematical programming model to estimate service times scientifically, using billing codes and occurrence data from internal medicine clinics instead of self-reported methods. Key findings of this study are as follows: first, initial consultation services show the highest estimated service time; second, initial consultations require longer time than follow-up visits; and third, the lowest estimated time was observed in glucose testing (semi-quantitative) codes. These results align with common expectations, demonstrating the feasibility of accurately estimating service times using engineering-based approaches. This study’s findings not only validate general assumptions about consultation durations but also provide foundational evidence for the application of engineering methods in calculating service times for healthcare services in Korea.