[논문]외래⦁입원 환산지수에 기초한 2020년도 환산지수 산출 연구

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doi:10.5762/kais.2021.22.4.183

[국내논문] 외래⦁입원 환산지수에 기초한 2020년도 환산지수 산출 연구
A Study on the introduction of the outpatient and inpatient conversion factors in the 2020 Physician Fee Contract 원문보기

한국산학기술학회논문지 = Journal of the Korea Academia-Industrial cooperation Society, v.22 no.4, 2021년, pp.183 - 194

초록
AI-Helper

본 연구에서는 SGR 모형과 AR 모형으로 부터 개발된 유형별 외래 및 입원 환산지수 분리 모형을 바탕으로 실제 건강보험 진료비 자료를 사용하여 2020년도 환산지수를 추정하였다. 또한 유형별 환산지수 계약 하에서 병원의 단일 환산지수 조정률과 외래 및 입원으로 분리된 복수의 환산지수 조정률을 산출하였다. 마지막으로 환산지수 분리 모형이 의료전달체계를 확립하기 위한 수단의 하나로 효과적으로 사용되기 위한 정책적 방안을 제안하였다. 본 연구의 주요 결론은 다음과 같다. 첫째, r=0.1에서 2020년도 병원의 단일 환산지수 조정률은 2.0%이며 병원의 환산지수를 분리하는 경우 외래 및 입원 환산지수 조정률은 각 각 2.2%, 2.3%로 나타났다. 그리고 조정계수를 활용하여 외래 및 입원 환산지수를 결합하는 방안을 제시하였다. 둘째, 의료전달체계 확립을 위한 조치의 하나로 제안된 가산율 조정 방식 대신에 가산율과 환산지수를 연동하여 운영하는 방안을 제안하였다. 셋째, 병원⦁의원 등 유형별로 외래환산지수, 입원환산지수, 조정계수를 도입하는 것에 추가해 진료량에 대한 목표관리를 가능하게 하는 모형 개발이 필요하다.

Abstract ▼ AI-Helper

In this study, the conversion factor for 2020 is estimated based on an outpatient and inpatient conversion factor separation model developed from SGR and AR by using actual medical expense data. In addition, a policy plan is proposed to calculate the values of single and multiple conversion factors for each type of medical expense, and to effectively use the conversion factor separation model as one of the means to establish a medical delivery system. The major results are as follows. First, at r=0.1, the rate of adjustment in the hospital single conversion index in 2020 was 2.0%, and the outpatient and hospitalization conversion rates for hospitals were 2.2% and 2.3%, respectively. In addition, a combination of outpatient and inpatient conversion factors can be used for the adjustment. Second, as a measure to establish a medical delivery system, instead of adjusting the addition rate, a method of interlocking the addition rate and the conversion factor is proposed. Third, it is necessary to develop a model that enables target management of volumes, in addition to the outpatient conversion factor, the inpatient conversion factor, and the adjustment coefficient.

Keyword

표/그림 (24)

표 Table 1. yearly SGR
표 Table 2. mei
표 Table 3. Total medical expenditure (unit : billion ₩)
$Table 4. <TEX>$d^a_{j,t_{(n=1)}}$</TEX> from EQ3.$ 표 Table 4. $d^a_{j,t_{(n=1)}}$ from EQ3.
표 Table 5. ΔCF_{t_(N=1)} based on adjustment coefficient for r
표 Table 6. rate of adjustments on conversion factor
표 Table 7. outpatient medical expenditure (unit : ₩B)
표 Table 8. inpatient medical expenditure (unit : ₩B)
$Table 9. <TEX>$d^{a,o}_{j,t_{(n=1)}}$</TEX> from EQ 3.(Outpatient)$ 표 Table 9. $d^{a,o}_{j,t_{(n=1)}}$ from EQ 3.(Outpatient)
$Table 10. <TEX>${\Delta}CF^o_{t_{n+1}}$</TEX> based on adjustment coefficient for r$ 표 Table 10. ${\Delta}CF^o_{t_{n+1}}$ based on adjustment coefficient for r
표 Table 11. adjustment rates of conversion factor (outpatient)
$Table 12. <TEX>$d^{a,i}_{t_{n+1}}$</TEX> from EQ 3.(Inpatient)$ 표 Table 12. $d^{a,i}_{t_{n+1}}$ from EQ 3.(Inpatient)
$Table 13. <TEX>${\Delta}CF^i_{t_{n+1}}$</TEX> based on adjustment coefficient for <TEX>$r_i$</TEX>$ 표 Table 13. ${\Delta}CF^i_{t_{n+1}}$ based on adjustment coefficient for $r_i$
표 Table 14. adjustment rates of CF (total, α = 0.6 )
표 Table 15. Ratio of Mild Diseases to Total Patient Visit Days_Ratio1(thousand days)
표 Table 16. Ratio of Mild Diseases to Total Outpatient Visit Days_Ratio2(thousand days)
표 Table 17. Estimated medical expense of mild diseases based Ratio1
표 Table 18. Estimated medical expense of mild diseases based on Ratio2
표 Table 19. Ratio of Severe Diseases to Inpatient Medical Expense
표 Table 20. Copayment for uninsured medical expenses of cancer patients (unit : ￦B)
표 Table 21. Classification of medical expenses by disease severity and type_2017 (unit : ￦B)
표 Table 22. Classification of medical expenses by disease severity and type_2018 (unit : ￦B)
표 Table 23. Addition rate and conversion factor for tertiary hospital by scenario
표 Table 24. Addition rate and conversion factor for genaral hospital by scenario

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