의료행위 분류체계에 관한 비교 연구 : 국제의료행위분류(ICHI)의 체계적 도입방안을 중심으로

국문 초록 (Abstract)

보건의료체계의 효율성, 구조 및 질 등에 초점을 둔 의료행위의 국제적 비교요구가 점점 증가함에도 현재 세계 각국의 의료행위 분류체계는 국가별 필요에 의해 개발하여 사용하고 있어 국가간 비교 가능한 보건의료행위 통계작성이 어려운 상황으로, 이런 문제점들을 해결하기 위해 세계보건기구(WHO)에서는 2018년 완성을 목표로 국제의료행위분류(ICHI)를 개발 중에
있다. 이에 우리나라도 의료행위분류체계의 국제적 표준이 될 ICHI 개발상황에 맞춰 한국형 의료행위분류 제정안 마련을 위한 준비가 필요하다.
현재 우리나라의 행위분류의 도구로 사용되고 있는 ICD-9-CM(Vol.3)은 오래된 분류체계로써 개정관리 등 분류체계에 대한 후속관리가 제대로 이루어지지 못해 정합성 있는 자료구축의 도구로서 적합하지 못한 상태이며, 건강보험청구를 목적으로 개발한 건강보험수가코드분류(EDI) 역시 급여 범위에 한정되어 있는 비체계적인 수가 목록이라는 문제점을 드러내고 있다.
본 논문에서는 국제의료행위분류 개발 완료 이후 국내 도입방안에 대하여 연구하였다. 우선 국제의료행위분류에 대한 개념과 개발 배경, 국내․외 의료행위분류체계 사례를 비교·분석하였다.
연구 결과, 향후 국제의료행위분류 개발 이후 국내 실정에 맞게 적용하고 그 활용도를 제고하기 위한 체계적 도입방안을 제시함으로써 한국형 의료행위분류체계 구축 기반을 제공하였다.
향후과제로 ICHI 추가 개발 동향을 지속적으로 주시하면서, 특이성 부족, 상세성 부족 등 ICHI가 지니고 있는 한계점을 극복하기 위한 방안들에 대한 추가적인 연구 필요성을 제시하였다.

목차 (Table of Contents)

• 목 차
• 제1장 서론 ··················································································1
• 1.1 연구의 배경 및 목적 ····················································································1
• 1.2 연구의 범위 및 방법 ····················································································2
• 제2장 국제의료행위분류 개념 및 이론적 고찰 ··················4
• 2.1 국제의료행위분류(ICHI)의 개념 ································································4
• 2.2 국제의료행위분류(ICHI)의 개발 배경 ······················································5
• 2.3 국제의료행위분류(ICHI)의 목적 및 범위 ················································6
• 2.3.1 목적 ·············································································································6
• 2.3.2 범위 ·············································································································7
• 2.4 국제의료행위분류(ICHI)의 축 구조와 내용개발 ····································8
• 2.4.1 축 구조 ·······································································································8
• 2.4.1.1 대상(Target) ·······················································································10
• 2.4.1.2 행위(Action) ························································································11
• 2.4.1.3 방법(Means) ························································································12
• 2.4.2 내용 개발 ··································································································13
• 2.4.2.1 내과 및 외과 의료행위 ·····································································13
• 2.4.2.2 기능 의료행위 ·····················································································14
• 2.4.2.3 공중보건 의료행위 ·············································································14
• 2.4.2.4 일차진료 의료행위 ·············································································14
• 2.4.2.5 외래환자/통원치료환자 의료행위 ·························15
• 2.2.3 코드 수 비교 ····································15
• 제3장 국내․외 의료행위분류체계 사례연구 ····················16
• 3.1 국내 의료행위분류체계 동향 ···················16
• 3.1.1 ICD-9-CM 제3권 ····························16
• 3.1.2 건강보험요양급여비용 코드(EDI) ···············18
• 3.1.3 한국표준의료행위분류(KCPM) ···················18
• 3.1.4 한국보건의료표준용어(KOSTOM) ··············19
• 3.1.5 의료행위분류체계별 적용 법률 ····················20
• 3.2 국외 의료행위분류체계 동향 ·······················21
• 3.2.1 호주 의료행위분류체계(ACHI) ······················22
• 3.2.2 캐나다 의료행위분류체계(CCI) ·····················25
• 3.2.3 미국 의료행위분류체계(CPT) ··············27
• 3.3 국내·외 의료행위분류체계 비교 ······················29
• 3.3.1 분류의 범위 ·····································29
• 3.3.2 분류의 축(Axis) ····································30
• 3.3.3 세분화 정도(Granularities) ·······························31
• 3.3.4 부가적 요소(Modifiers/Qualifiers) ····························32
• 제4장 국제의료행위분류(ICHI) 체계적 도입방안 ·············33
• 4.1 분류체계 관리 측면 ····································33
• 4.1.1 분류체계 관리원칙과 방법 정립 ························33
• 4.1.2 적절한 분류체계 관리 운영을 위한 거버넌스 구축 ········34
• 4.1.3 전자적 환경에 적합한 콘텐츠 제공체계 수립 ············34
• 4.1.4 국제적 네트워크 유지 및 활발한 참여를 통한 지속적 발전 가능성 확보··· 34
• 4.1.5 사용자 교육자료 개발 및 환류체계 운영 ···············35
• 4.2 분류체계 활용 측면 ·······························35
• 4.2.1 ICHI의 관점에서 현행 분류체계의 정리와 활용 ········35
• 4.2.2 다양한 통계 콘텐츠 활용체계 구축 ··················36
• 4.2.3 지불제도의 활용가능성 검토 ·······················36
• 4.2.4 질높은 퇴원요약 자료수집 체계 구축 ················36
• 제5장 요약 및 향후 과제 ······················································37
• 5.1 연구결과 요약 및 한계 ·····························37
• 5.2 향후과제 ······························································38
• 참고 문헌 ····················································41
• <부록1> 국외 의료행위분류체계 운영현황 비교 ···············43
• <부록2> 국가별 보건의료 분류체계 사용현황 ·····················44
• <부록3> 국제의료행위분류(ICHI) 개발 경과 ····················45
• <부록4> 세계보건기구-보건의료분류표준(WHO-FIC) 분류체계 현황 ···········46
• Abstract ································································47