The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017

Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (þ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.

Health insurance and user fees: a survey of health service utilization and payment method in Mushin lga, Lagos, Nigeria

Background: Studies have documented how out-of-pocket payments (OOP) and user fees result in catastrophic health expenditures, providing evidence that health systems are better financed through prepayment mechanisms such as health insurance. Aim: This study sought to determine the perception of community residents to health insurance, their pattern of health service utilization and method and amount of payment. Methods: This descriptive cross-sectional study among 422 household members in Mushin LGA obtained data on sociodemographic characteristics, perception of health insurance, enrollment status and willingness to enroll; last use of health services and method of payment for health care services. Data analysis was done with Epi-info (ver 7) and results were presented as frequencies, percentages, means and standard deviations. Statistically significant associations were determined using the Chi-square test at significance level of p < 0.05. Results: Over half the respondents (56.6%) had not heard about health insurance. Very few (19.7%) were enrolled. Of those not enrolled, 57.1% were willing to consider buying health insurance. The method of payment for health services reported by respondents was OOP (98.3%). Those in younger age groups, with higher levels of education and higher household incomes reported having heard of health insurance. Higher educational level and household incomes were positively associated with willingness to enroll in a health insurance scheme. Conclusion: Awareness was insufficient, health services were paid for mostly from OOP. The authors recommend taking the opportunity to encourage uptake of health insurance for young adults and those in low- and middle-income households

Medical charges and the cold reality of surgeons of Korea

Surgery is a very hands-on area of medical care, in that surgeons identify problems in patients' bodies and directly change them through operations. Therefore, it is not only necessary for surgeons to have a high level of expertise, but also to take considerable responsibility for the outcomes of each operation. However, surgery, which was once an object of envy, has long been a process to avoid, due to various circumstances, such as abnormal medical expenses in the medical field and social phenomena that avoids difficult work. It is unfortunate that medical professionals do not receive sympathy from others within the same medical field because of the general difficulties of the profession. The fundamental problem in this situation is the abnormal profit structure of the Korean medical system. Efforts by various related organizations will be needed to objectively evaluate the problems of the current medical insurance system and to make reasonable adjustments considering the difficulty, frequency, and resource-intensiveness of medical care.

Differences among Ophthalmology Patients Referred to Tertiary Medical Centers according to Referral Hospital

PURPOSE: This study aimed to investigate the diagnosis and severity of patients who were referred to tertiary medical centers according to the type and function of the referral hospitals. METHODS: First-visit patients referred from July 2015 to June 2016 were retrospectively reviewed with regard to referral hospital, final diagnosis, treatment necessity, and medical fees for the six months after their first hospital visit. Based on these data, differences in type and function of medical institution were examined. RESULTS: In a comparison of hospitals according to their number of beds, clinics, hospitals and, tertiary hospitals had no differences in the ratio of patients who needed treatment (p = 0.075) and their medical fees over six months (p = 0.372). When hospitals were classified by functional capability in terms of doctors' medical specialty, increasing ratios of patients requiring medical treatment (p < 0.001) and medical fees for six months (p < 0.001) were found in the order of non-eye specialists, eye specialists, and eye specialists in trainee hospital. CONCLUSIONS: Efficient healthcare delivery systems should classify medical institutions by functionality capability based on medical specialties rather than hospital size according to the number of beds.

Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.

Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.

The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

OBJECTIVES: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. METHODS: We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. RESULTS: During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. CONCLUSION: More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement.

Current status and future prospects of trauma centers in Korea

The government has implemented a regional trauma center project since 2012 with the goal of reducing the preventable trauma death rate in Korea to the level of developed countries. Regional trauma centers should organically cooperate with the government and the Korean Surgical Society to ensure that seriously injured patients are treated at regional level 1 trauma centers and to lead quantitative and qualitative growth with the aim of ensuring leadership within the regional trauma system. We expect that the finances of trauma centers will stabilize and that the role of trauma centers will become more mature by readjusting medical fees to a realistic level and expanding the scope of treatment to include acute care surgery. These efforts will ultimately reduce the preventable trauma mortality rate in Korea.

Status of two-week illness for primary and secondary students in middle and west provinces / 中南大学学报(医学版)

To explore the status of two-week illness in primary and secondary students and to provide the basis for rationally distributing heath resources in primary and secondary schools.
 Methods: Stratified cluster sampling method was used to select 6 744 primary and secondary students aged from 9.0-16.9 years, and the name or symptoms of two-week illness, frequencies, medical expenses and days of sick leave were surveyed by using the self-made questionnaires.
 Results: Respiratory system disease (73.6%) and digestive system diseases (13.2%) were the major two-week illness. When they were ill, 58.9% students went to hospital, 39.9% took medicine by themselves, and 1.2% received non-treatment. The two-week morbidity, sick frequencies, average medical expenses per time and days of sick leave were 12.6%, (1.34±0.81) times, 10.0 yuan, and (0.39±0.98) days, respectively. The two-week sick frequencies, average medical expenses per time and days of sick leave among primary or secondary students were (1.37±0.87) or (1.26±0.69) times, 12.0 or 9.0 yuan, and (0.44±1.14) or (0.30±0.55) days, respectively. There was a positive correlation between two week sick frequencies and medical fees per time, or days of sick leave (r=0.301, r=0.275 for primary students, respectively, P<0.01; r=0.334, r=0.290 for secondary students, respectively, P<0.01). The positive correlation between medical fees per time and days of sick leave was also found (r=0.312, r=0.343 for primary students and secondary students, respectively, P<0.01).
 Conclusion: Characteristics of two-week illness among primary and secondary students possess common symptoms, frequent, low medical expenses per time. The frequencies, medical expenses and days of sick leave in primary students were increased compared with that in secondary students.

The collapse of infrastructure for childbirth: causes and consequences

Despite low childbirth rate in Korea, the number of women with high-risk pregnancies is steadily increasing, mostly due to increased maternal age, multiple pregnancies, and obesity. In fact, one out of five Korean women is above 35 years old at childbirth. It is well known that high risk pregnancy is closely related with increased maternal mortality, either by direct or indirect causes. Despite such problems, however, Korea's health care infrastructure for childbirth has deteriorated, leaving approximately 20% of the geographic area of the country medically underserved with regard to optimal maternity care. Such a collapse has been caused by the decrease in the number of maternity hospitals and their financial difficulties due to medical fee reimbursement for childbirth being too low. The problem is aggravated by a lack of obstetricians who can provide skilled attendance at childbirth. In addition, extensive legal pressure has dissuaded talented medical students from pursuing obstetrics and gynecology, thereby resulting in aging and severe gender imbalance in such professions. The direct consequence of the collapse in infrastructure for childbirth is an increased maternal mortality ratio, especially in underserved areas. Moreover, increased maternal death caused by postpartum bleeding reflects an obvious sign of danger in the maternal health care system. Furthermore, the number of tertiary hospitals that can provide optimal care to high risk pregnant women has decreased to two-thirds of what it once was, and the training of competent obstetricians for the mothers of the future continues to be a difficulty.

Program for obstetric care supporting underserved areas in Korea: outcome and evaluation standards

In 2011, the government of South Korea established a support program for obstetric care for underserved geographical areas to address the serious problem of the low birth rate. The birth rate of some underserved areas has since been increasing, and several indexes of mother and child health have since improved. However, various problems have also been noted in the evaluation of the policy for this support program. The birth rate of some rural areas remains low, and the inadequacy of professional health care providers has not been resolved. The medical fee for delivery should be rationalized, and countermeasures for medical litigation should be established. Furthermore, better communication between local residents and healthcare providers are necessary to improve maternal and child health. For effective long-term provision of obstetric care through this support program for underserved areas, new outcome and evaluation standards are necessary. Critical requirements for launching an initial support program and outcomes including the birth rate and indices of maternal and child health should be itemized and assessed. Support for health care providers requires expansion including support personnel, the establishment of a transfer system, and measures to address legal problems. A multifaceted approach including regular maternal education and an information network system for local residents is necessary. Future support programs should include total care for maternal and child health, so cooperation of the government offices and health care centers is essential. At the same time, new standards of evaluation of obstetric care support programs for underserved areas need to be established for appropriate evaluation of comprehensive family health.

Shortage in residents of internal medicine and current status of Korean medical system

The shortage of internal medicine residents depict the contradictions and perversions in Korean medical system. Internal medicine is the foundation of medicine and the fact it serves as the most essential medical services for the people adds severe gravity to the issue. The fundamental problem derives from the contradictions in health insurance system. In fact, the poor medical fee and the failure of medical delivery system are the core drawbacks to the current crisis. Unless above matters are addressed to draw a constructive resolution, it is an undeniable fact that this may become a serious threat to the national health system and people's wellbeing.

Cost-effectiveness Analysis of Home Care Services for Patients with Diabetic Foot / 간호행정학회지

PURPOSE: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. METHODS: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. RESULTS: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. CONCLUSION: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses / 예방의학회지

OBJECTIVES: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. METHODS: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. RESULTS: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. CONCLUSIONS: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

Unexpected red cell antibody detection by conditional combination of LISS/Coombs and NaCl/Enzyme gel tests at a tertiary care hospital in Korea: A 5-year study

BACKGROUND: A combination of the LISS/Coombs and enzyme methods is recommended for identifying unexpected antibodies. However, many laboratories in which tests are to be performed within the limits of medical fees covered by insurance, use only the LISS/Coombs method because the permissible medical fee is low as compared to the price of reagents required for both methods. The NaCl/Enzyme gel is used as a secondary assay when the LISS/Coombs gel test yields inconclusive results. We compared the frequency of unexpected antibody identified by LISS/Coombs gel with that obtained by the conditional combination of LISS/Coombs and NaCl/Enzyme gels. We aimed at establishing evidence-based guidelines for antibody testing. METHODS: From June 2007 to June 2012, antibody screening was performed for 69,986 samples; subsequently, antibodies were identified in samples showing positive screening results. These initial screenings and identifications were performed using the LISS/Coombs gel. We considered the results "inconclusive" when specific antibodies were not identified or reactions were too weak for accurate interpretation. For the inconclusive samples, we subsequently used NaCl/Enzyme gels. RESULTS: The overall detection rate of unexpected antibodies was 1.23%. Among the samples analyzed using NaCl/Enzyme gels, 40.2% showed results different from those obtained using LISS/Coombs gels. Moreover, 41.9% of samples with nonspecific reactions in LISS/Coombs gels showed clinically significant Rh or Kidd antibodies with NaCl/Enzyme gels. CONCLUSION: Considering both patient safety and cost effectiveness, we recommend the use of conditional combination of LISS/Coombs and NaCl/Enzyme gels for antibody detection, especially in laboratories that must perform tests within an established budget.

Comparative study on medical fees: caesarean section, cataract, and appendectomy surgeries among OECD countries

The question has been raised whether the medical fee schedule is very low in Korea. However, studies that empirically address this matter on a national scale are rare. This study attempted to determine the level of Korea's medical fees for caesarean section (C-section), cataract, and appendectomy surgeries by comparing and analyzing them with other Organization for Economic Cooperation and Development (OECD) countries' medical cost data obtained from other studies. There are two ways to compare the level of medical fees: one is a direct comparison, which obtains each country's medical fee schedule and compares them with each other. Another is indirect comparison, a method which compares data such as physician income. For direct comparison, fees were calculated using data provided by the OECD and Health Insurance Review and Assessment. For indirect comparison by physician income, data obtained from Korea Employment Information Services were used to represent Korean physician income. When compared with other OECD countries, the results suggest that, overall, the Korean fee schedule could be low, based on the fees for C-section, cataract, and appendectomy surgeries. The study results also confirm that Korean physicians' average earnings ranked relatively low among OECD countries. These results are meaningful in that they empirically support the contention that Korean medical fees could be low. In addition, under what is known as national health insurance, in which the medical fee schedule is determined by a single payer, an empirical analysis on medical fee levels, as in this study, has substantial political implications because it may be utilized for medical fee schedule negotiation in the near future. An attempt to directly research fees and the range of services of OECD countries is still needed in order to provide more established data.

Honorários de um cirurgião na Justiça (Vila Boa de Goiás, 1801) / A surgeon's fees in court (Vila Boa de Goiás, 1801)

Estuda-se a ação judicial de cobrança de honorários, proposta em Vila Boa de Goiás (1801), pelo cirurgião-mor André Villela da Cunha Roza, sendo ré a senhora Joanna da Fonseca Coutinha. Enfoca-se a prestação de assistência médica aos escravos, a escassez e o encarecimento deles, a precariedade da formação de físicos e cirurgiões, assim como problemas éticos na cobrança dos honorários em questão.

The article explores the lawsuit brought by Surgeon-Major André Villela da Cunha Roza against Joanna da Fonseca Coutinha in Vila Boa de Goiás in 1801 to recover fees for his services. It examines the health care rendered to slaves, the scarcity and rising prices of these captives, the precarious training received by doctores and surgeons, and the ethical issues entailed in charging the fees in question.

Análise comparativa entre os códigos de ética odontológica e médica brasileiros / Comparative analysis of Brazilian medical and dental ethics codes / Análisis comparativo de los códigos brasileros de ética médica y dental

Os códigos de ética profissional são normas jurídicas (resoluções de autarquias federais) elaboradas pelos membros das mais diversas categorias de trabalhadores com o intuito de orientar a condutas desses profissionais no que diz respeito à ética na relação com os pacientes, com seus pares e com a sociedade. O objetivo deste estudo foi realizar uma análise comparativa entre os Códigos de Ética Odontológica e Médica. Observou-se que as diferenças entre estes documentos deontológicos surgem muito mais em virtude das particularidades de cada profissão do que por abordagens distintas frente a problemas similares. Concluiu-se que os Códigos de Ética Odontológica e Médica apresentam muito mais pontos em comum do que diferenças, mas seria interessante que os Conselhos de classe ao propor atualizações e modificações dos seus atuais códigos observassem o que as outras profissões da saúde contemplam em suas normas deontológicas, com o intuito de levar em consideração aspectos que também poderiam ser importantes para sua classe profissional de modo a engrandecer os códigos tornando um pouco mais fácil para os médicos e cirurgiões-dentistas a tomada de decisões éticas no seu trabalho diário em benefício da saúde do ser humano e da coletividade.

Los códigos de ética profesional son normas (resoluciones de autoridades federales) preparadas por los miembros de las diferentes categorías de trabajadores con el fin de orientar la conducta ética de estos profesionales en la relación con pacientes, colegas y la sociedad. El objetivo de este estudio fue realizar un análisis comparativo de los códigos de ética en Odontología y Medicina. Se observó que las diferencias entre estos documentos se deben más a las particularidades de cada profesión que a enfoques distintos frente a problemas similares. Se concluyó que los códigos de ética en Odontología y Medicina presentan más puntos en común que diferencias, pero sería interesante que los Consejos de Clase, al proponer actualizaciones y cambios a sus actuales códigos, observaran lo que otras profesiones de la salud contemplan en sus normas deontológicas, con fin de tener en cuenta aspectos que también podrían ser importantes para su clase profesional, de modo de ampliar los códigos y hacer un poco más fácil para los médicos y cirujanos dentistas la toma de decisiones éticas en su trabajo diario en beneficio de la salud del ser humano y la comunidad.

Professional ethics codes are norms (federal authority resolutions) prepared by members of the different categories of workers with the goal to guide the ethical conduct of these professionals in relation to patients, colleagues and society. The aim of this study was to carry out a comparative analysis of ethical codes in Dentistry and Medicine. It was observed that differences between these documents were due more to the particularities of each profession than to different focus, facing similar problems. It was concluded that Dentistry and Medicine ethical codes have more points in common than differences, but it would be interesting that Class Advisory Committees, when proposing actualizations and changes to their current codes, they will look what other health care professions view as deontological norms, with the end to have into account aspects which may be important also for their professional class, in order to extend the codes and facilitate to physicians and dentists ethical decision making in their daily task in benefit to the health of human beings and community.

Cost Aspects of Radical Nephrectomy for the Treatment of Renal Cell Carcinoma in Korea: Open, Laparoscopic, Robot-Assisted Laparoscopic, and Video-Assisted Minilaparotomy Surgeries

PURPOSE: This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). MATERIALS AND METHODS: Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. RESULTS: The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791+/-240,757, 2,024,246+/-674,859 (p=0.998), 3,603,557+/-870,333 (p<0.01), and 8,021,902+/-330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627+/-231,957, 1,798,127+/-645,602 (p=0.634), 3,039,769+/-711,792 (p<0.01), and 899,668+/-323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163+/-24,581, 226,119+/-215,009, 563,788+/-487,798 (p<0.01), and 7,122,234+/-56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. CONCLUSIONS: VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.