Determination of Health Insurance Fee Schedule and Strengthening Policy for Health Insurance Coverage / 대한내과학회지

The resource-based relative value scale (RBRVS) was introduced in Korea as a payment system in 2001. However, the health insurance fee schedule had many problems. Unbalanced insurance fee schedules still occur, and the relative value was not divided between physicians' work and practice expenses. Furthermore, malpractice fees were not included in the total RBRVS. The first refinement project of the health insurance relative value scales was conducted in 2003 and the second project started in 2010. In the first project, final relative values were calculated under budget neutrality by medical departments, and imbalances within the departments were resolved. However, imbalances still existed between departments. In the second project, final relative values were classified and computed by the type of medical treatment. The final RBRVS has been applied step by step since 2017 and the imbalance problem of the insurance fee schedule has been partially resolved. The government recently announced strengthening the plan for health insurance coverage. The current coverage rate for total medical costs by national health insurance is 63%. The purpose of this plan was to increase the coverage rate by up to 70%. The government has suggested detailed plans but there remain many controversial issues and limitations with regard to the practical aspects. Thus, further research and suggestions are needed.

A Review of the Classification of the Practice Characteristics and the Physicians' Work in Vascular Surgery

PURPOSE: Since the medical insurance system was started in Korea, there has been an imbalance in the medical charges among the procedural items of special departments. For correcting this problem, the Resource-based Relative Value Scale (RBRVS) was introduced to determine the relative values of physician services and practices. The RBRVS is the prevailing model used today to describe, quantify and reimburse physicians for their services. In this study we attempted to clarify the relative values of the practice characteristics in vascular surgery and evaluate the propriety compared with the relative value unit (RVU) of the American Medical Association (AMA). METHOD: The classification of practice characteristics in vascular surgery was compared with that of the AMA. The propriety of physicians' work was measured according to the Korean and American physicians' work. The rate more than 70, between 50 to 69, and less than 49 were used to decide over-, proper- or under-estimation, respectively. RESULT: The ratio of the number of practice characteristics in Korean and American vascular surgery was 1:3.31 (97:321). The over-, proper- or under-estimated physicians' work among the identical American practice characteristics was 8/46 (17.4%), 19/46 (41.3%) and 19/46 (41.3%) respectively. CONCLUSION: Our results demonstrated that the practice characteristics of Korean vascular surgery are not sorted by detail and a large percentage of physicians' work (41.3%) is under-estimated. Therefore, reasonable payment for physician services or practices can not be determined for Korean vascular surgery.

A Study on the Blood Processing Costs in Hospital Blood Banks / 대한수혈학회지

BACKGROUND: The blood processing works are composed of phlebotomy, donor testing, manufacturing, storage, transportation, and quality control. Among these, storage, transportation and quality control are done partially at the blood collection centers and finally accomplished at the hospital blood banks. We tried to analyze blood processing costs in hospital blood banks. METHODS: Blood processing costs are divided into physician works, practice expenses, and professional liability insurance according to RBRVS (Resource-Based Relative Value Scale). Physician works were analyzed according to the study of the 'Physician work RBRVS committee of the Korean society for laboratory medicine'. For the practice expenses, three university hospital blood banks data were analyzed. The costs for the blood supply of small clinics or hospitals without blood banks were investigated by questionnaire. RESULTS: Comprehensive works of physician were such as laboratory administration, quality control, preparation of procedure manual, education, quality improvement control. Specific works of physician were such as supervision over technologists, analysis of quality control data, management of blood inventory, storage and issue, blood utilization review, management of adverse transfusion reaction, blood return and disposal. As for one unit of blood, the standard labor time of technologists was 28.8 minutes (which is equivalent of 7,680 won) and the mean equipment cost was 592 won. The mean cost of small clinics or hospitals for blood supply was 12,150 won. CONCLUSION: The reimbursement of blood processing cost for the hospital blood bank would contribute to stable blood bank administration, stable blood supply and safe transfusion.

Estimation of Psychiatric Nursing Costs by Using the Resource-Based Relative Value Scale(RBRVS) / 간호학회지

This study was conducted to assess the amount of nursing services for psychiatric inpatients and to estimate psychiatric nursing costs by using the RBRVS. Full details of medical services, including physician and nursing services, for psychiatric inpatients were surveyed and data of general characteristics of hospitals and patients were also collected. The cost of nursing activities was estimated by the multiple conversion factor which was drawn from the Korean RBRVS Development Project to the RBRVS score of each nursing activities, which was drawn from the results of Korean Nurses Association (KNA)'s projects about nursing RBRVS development and cost of nursing activities. The data about 89 inpatients from 3 general hospitals with psychiatric departments were analyzed. The total cost of nursing activities for each patient per admission day was from KRW 22,185 to KRW 27,954 by hospital, and KRW 25,220 in average. The percent of nursing cost to the total cost of medical services was from 36% to 48% by characteristics of patients and 41.4% in average. The cost of nursing activities estimated in this study was between the existing NHI fee schedule and the one suggested by KNA. It is considered as appropriate and acceptable level compared to the total amount of medical services. In the process of KNA's activities to get nursing fee in NHI fee schedule, results of additional studies to estimate the cost of nursing activities balanced with total cost of medical services in every departments should be found and utilized.