한국 노인틀니 보험급여를 위한 보험재정 추계에 관한 연구 = STUDY ON AN ACTUARIAL BUDGET OF INSURANCE PAYMENT FOR DENTURE SERVICE OF KOREAN GERIATRIC PATIENTS

다국어 초록 (Multilingual Abstract)

The use of insurance to help spread the financial burden attendant upon geriatric populations in Korea is of a governmental issue. Much of recent issues is the effort to apply this principle to current dental expenses. Therefore, the purposes of this study were (1) to determine the actuarial budget of national insurance payment for denture services of Korean geriatric patients whose age are more than 70-year and (2) to provide a guideline for the national oral health care policy of the insurance payment system for denture service.
An opinion survey form was mailed to an approximately 10% of general dental practitioners (1,164) and 260 returned survey responses were analyzed. Also, conducted were a telephone interview with 64 general dental practitioners who were willingly participated out of initial contact of 80 practitioners concerning, all expenses incurring for the maintenance of dental clinics and personnel. Preexisting informations concerning the dental technician's fee schedule and the cost of materials needed for the construction a denture were also complied form the Korean Dental Technician's Association and the Korean Association for Dental Materials and Instruments for the actuarial cost to determine the total budget and insurance payment for the denture services of geriatric population in Korea. The results were as follow.
1. A 64.6% of dentists agreed to as a carrier of beneficiary of national denture services for a group of more than 70 years of age. A 73.5% of dental practitioners responded that the selection of the carrier of beneficiary of the denture services is based on the national medical insurance plans regardless of the age of individuals. A 23.5% of the responses agree to expand the denture service to all prosthodontic patients.
2. As far as the area of national insurance plans for denture services are concerned, a 93.9% and a 77.5% agreed in the resin-based full dentures only for full denture and in the non-precious metal cast for partial denture respectively. Therefore, the results clearly indicated that both types of denture services need to be included for the national oral health care program.
3. As far as the indemnity for the prosthodontic coverage is concerned, the survey results indicated a 693,000 won for resin-based full denture and 708,000 won for non-precious metal cast. Dentists are more favor of a monetary (77.3%) than material (20.4%) reimbursement system.
4. When the actuarial cost for the prosthetic appliance only with the time of services rendered, the materials used and the fee for dental technician were calculated without the consideration of difficulty of the prosthetic services, the cost for resin-based full dentures and non-precious metal cast partial dentures were a 560,484 won and 594,160 won respectively.
5. When the actuarial cost for the prosthetic appliance were calculated with the consideration of difficulty of the services which were based on relative service index of 6,567 won per hour, the basic expenses of service rendered, the current insurance payment schedule and the personnel expense for services by a hygienist, the cost for one resin-based full denture and one non-precious metal cast partial denture were a 589,714 won and 610,296 won respectively.
6. If all geriatric population, who need for denture services and their age is more than 70 years-old in Korea, were provided the necessary services in 1998, the total actuarial cost of 80.2 billion won for the resin-based full dentures and 227.1 billion won for non-precious cast metal partial dentures, respectively. If these cost were estimated by the current insurance reimbursement plans in which 30% of expense-sharing by the patient, the total expenditure to the Korea Health Care Union is a 215 billion won comprising of 56.1 billion won for the resin-based full dentures and 158.9 billion won for non-metal cast partial dentures. However, the acturial costs will be decreased as a function of time because the number of patients who need a new denture service will be decreased as their denture services were provided.
7. If al geriatric population, who need for denture services and their age is more than 70 years-old in Korea, were provided the necessary services under the base of 300,000 won per a denture service in 1998, the total expenditure of 150.5 billion won comprising of 40.7 billion won for the resin-based full dentures and 109.8 billion won for non-precious cast metal partial dentures, respectively. It is also expected that the cost will be decreased as function of time. Therefore, at present time, the most reasonable method is to revise the monetary reimbursement system to adjust the current situations.