활동기준 원가분석을 통한 건강보험수가의 적정성 분석

활동기준 원가분석을 통한 건강보험수가의 적정성 분석 = An Analysis on Appropriateness of Health Insurance Fee Using the Activity Based Costing(ABC) Approach

제목: 활동기준 원가분석을 통한 건강보험수가의 적정성 분석 = An Analysis on Appropriateness of Health Insurance Fee Using the Activity Based Costing(ABC) Approach

키워드: Activity Based Cost ; Health Insurance ; RBRVS ; Fees for Medical Services ; Cost Center

초록: The Activity Based Costing(ABC) means the process that makes clear how the actions and input resources have changed into service to calculate medical services costs. These days, the number of hospital which is using the ABC system is increasing to make their policy decision making efficient and run the hospitals more resonable. This study analyzes the unbalance in the level of health insurance service fee and the improvement plans based from 8 hospitals(ABC system) and 95 clinics(ABC survey). The cost recovery ratio has shown different levels according to each service type. A surgery service type recorded 76.8% and an evaluation & management service type is 84.6%, a treatment procedure type(85.8%), a function test type(91.6%) and health insurance fee even did not reach to the original cost. Meanwhile , a laboratory test type and imaging test type show high level of cost recovery ratio. they recorded 188.3% and 158.8%. Resultingly now of unbalance in the level of health insurance service fee accelerates supply of every test. so there is a need to make laboratory test type and imaging test type lower to keep balance with the surgery and medical service. These methods should be performed gradually with monitoring the unbalance fee ratio and for this, a panel medical institution have to be established for generalizations of studying result, fairness of selecting researching sample.

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