초록

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Abstract ▼ AI-Helper

Since the year 2000 that health care integration and separation of dispensing and prescribing function became effective, Korea"s health care financing has suffered from continuous deficit problem and the situation is expected to continue on in light of excessive care expense over care revenue over...

Since the year 2000 that health care integration and separation of dispensing and prescribing function became effective, Korea"s health care financing has suffered from continuous deficit problem and the situation is expected to continue on in light of excessive care expense over care revenue over the recent five years. Health insurance fee system has been long attributed to the cause of that problem. The purpose of this paper is to examine the effect of the introduction of the new health insurance fee system(thereafter DRG) to primary medical institution on the outpatient service fee. For this purpose, this study investigated the change of the outpatient service fee of eight primary medical institutions in three hypothetical situations. In the first hypothetical situation, the service fee difference between the present health insurance fee system and the DRG was investigated assuming that any change of the number of patients and medical personnel would not happen. In the second and third hypothetical situations, the service fee difference between the present health insurance fee system and the DRG was investigated allowing the change of the number of patients and medical personnel. The results of the study are as follows; First, in case of the first hypothetical situation, six among eight primary medical institutions has shown that DRG service fees are larger than the present service fees. The rest of two institutions has shown that DRG service fees are partly and wholly smaller than the present service fees. Second, in case of the second hypothetical situation which the service fees depend on the number of patients, the DRG system have shown effectively differential service fee schedule in eight primary medical institutions. Third, in case of the third hypothetical situation which serviece fees depend on the number of medical personnel, the DRG system have also shown effectively differential service fee schedule in eight primary medical institutions. Summing up, the DRG that apply to the outpatient service fee of the primary medical institutions in 3 hypothetical situations, on the whole, has shown the positive effect on both profitability and medical quality of primary medical institutions.

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