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.

The study on the development of relative value in medical treatment of the oral and maxillofacial surgery

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.

Practice Characteristics and Relative Value of Laboratory Physician's Work / 대한진단검사의학회지

BACKGROUND: The Korean Medical Association intends to determine the relative value of physician's work separately from the total relative value scale for each medical or surgical procedure. This study was designed by the Korean Society for Laboratory Medicine to determine the relative value of laboratory physician's work (LPW) in each diagnostic test. The LPW was clearly defined first and then its relative value was measured quantitatively on the basis of time and intensity of work. METHODS: LPW in the laboratory test was categorized into three parts, pre-service, intra-service, and post-service. The relative value of physician's work was measured using Rasch paired comparisons. RESULTS: Practice characteristics of LPW were clearly defined according to the pre-service, intraservice, and post-service. However, any laboratory physician's effort to improve the quality of laboratory work, which could not be measured in each test, had to be comprised in a pre-service designated separately as `comprehensive pre-service'. Rasch analysis based on the rating survey for LPW taken by a diverse group of laboratory medicine and other medical specialists revealed higher values than those assigned previously in many routine diagnostic tests (e.g., Gram stain, hemoglobin, anti-HBs, ABO cell type). The results obtained by applying Rasch regression analysis showed that the diagnostic tests that had been given a low relative value of LPW tended to be measured with more improved relative valuation. CONCLUSIONS: LPW for quality control and quality improvement was acknowledged with an improved relative valuation, even in the routine diagnostic test, as the results of Rasch analysis based on the rating survey. LPW might be further equated across the specialties, considering the practice characteristics of LPW.

Projection of Supply of and Demand for Psychiatrists in Korea / 신경정신의학

OBJECTIVES: Assuring adequate supply of specialist physicians is an important task in national health planning. An over-supply in a given speciality inflates health care cost, while undersupply increases the likelihood that population has a barrier in the access to basic health services needed. Only a few national specialty-specific physician planning studies have been undertaken in Korea. We forecasted the supply of and the demands for psychiatrists in the target year of 2015. METHODS: We adopted alternative projection models combined with demographic method as a supply forecasting method and Health Resources and Services Administration's demographic utilization-based model as a requirements forecasting method. The model uses selected data primarily from National Hospital Discharge Survey, database of the Korean Neuropsychiatric Association (KNPA) survey for certified members of KNPA, and Hospital Accreditation and Teaching Hospital Designation Report. We assumed two alternatives in supply forecasting by the number of medical students enrolled, and three alternatives in requirements forecasting based on future service utilization and physician productivity. RESULTS: Depending on assumptions, total psychiatrist supply ranged from 3,439 to 3,575 and requirements ranged from 1,873 to 4,048 in 2015. We estimated 162 surplus in 2005 and a 162 shortage of psychiatrist in 2015 based on high-level supply estimates and medium level requirements estimates. CONCLUSION: There would be no overt oversupply of psychiatrists in 2015 if the number of new residency positions is maintained at 4.6% of the number of medical students newly enrolled in a year. Further studies would be needed concerning comprehensive economic and institutional factors which could affect the requirements of psychiatrists.