The Calculation of Geographic Practice Cost Index and the Feasibility of Using It in Korean Payment System / 보건행정학회지

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91–0.98) was relatively low compared to the indices of other regions (0.96–1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.

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.

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.

A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices / 임상간호연구

PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

Diagnostic value of the Vesikari Scoring System for predicting the viral or bacterial pathogens in pediatric gastroenteritis / 소아과

PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.

Diagnostic value of the Vesikari Scoring System for predicting the viral or bacterial pathogens in pediatric gastroenteritis / 소아과

PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.

Escala CARE de empatia: tradução para o Português falado no Brasil e resultados iniciais de validação / CARE scale of empaty: translation to the Portuguese spoken in Braziland initial validation results

Objetivos: Traduzir e adaptar para uso no Brasil a escala de avaliação de empatia clínica Consultation and Relational Empathy (CARE). Fornecer resultados preliminares de validação concorrente dessa escala. Métodos: A escala em inglês foi traduzida e adaptada seguindo metodologia recomendada. Vinte pacientes atendidos em ambulatório de pneumologia em hospital público ligado ao Sistema Único de Saúde foram entrevistados quanto ao grau de compreensão da versão final do instrumento. Em uma segunda fase, doze pacientes do mesmo ambulatório responderam a versão brasileira da escala CARE e a Escala de Percepção de Empatia Pelo Paciente (EPEP), logo após término de consulta de rotina. Os médicos responsáveis pelo atendimento desses pacientes também foram convidados, após a consulta, a responder questionário contendo a versão brasileira do Interpersonal Reactivity Index (IRI) e o Inventário de Empatia (IE). Resultados: Dezenove dos 20 pacientes referiram grau elevado de compreensão dos itens da versão brasileira da escala CARE. O escore mediano da escala CARE para outros 12 voluntários foi 44,5 (20-63). O coeficiente alfa de Cronbach para as respostas dos últimos foi 0,867. Os escores CARE correlacionaram-se de maneira significante com os escores EPEP (r=0,699; p=0,01) e com o subitem altruísmo do IE (r=0,744, p=0,01). A escala CARE não mostrou correlações significantes com os escores globais das medidas de empatia IRI e IE informados pelos médicos. Conclusão: A versão brasileira da escala CARE é de fácil compreensão e exibe evidências aceitáveis de validade concorrente e consistência interna. Medidas de empatia referidas pelos médicos tendem a não se correlacionar com as percepções dos pacientes.

Objectives: To translate and to adapt the scale Consultation and Relational Empathy (CARE) for using in Brazil. To obtain preliminary results about concurrent validation of this scale. Methods: The scale was translated and adapted from English by appropriated recommended methodology. Twenty patients from the pulmonology clinic of a public hospital, associated with the Brazilian public health system, were interviewed about the degree of understanding of the scale final version. The second step of the study enrolled twelve patients from the same clinic who answered the Brazilian version of CARE and the Perception Scale of Empathy By Patients (EPEP), shortly after the end of aroutine consultation The physicians responsible for the care of these patients were also approached andasked to answer a questionnaire containing the Brazilian version of the Interpersonal Reactivity Index (IRI) and the Inventory of Empathy (IE). Results: Nineteen of 20 patients reported a high degree of understanding about the items of the Brazilian version of CARE. The median CARE score for other 12 volunteers was 44.5 (20-63). The Cronbach’s alpha coefficient for the answers of these patients was 0.867. CARE scores significantly correlated with EPEP scores (r = 0.699, p = 0.01) and with subsection altruism of the IE (r = 0.744, p = 0.01). CARE scale showed no significant correlations with global scores of IE and IRI reported by physicians. Conclusion: The Brazilian version of CARE is easy to understand and displays acceptable evidences of concurrent validity and internal consistency. Measures of empathy reported by doctors tend to not correlate with perceptions of patients.

Evaluando la situación financiera de los hospitales públicos a partir de los costos actualizados de sus prestaciones / Evaluation of financial status of public hospitals considering the updated costs of their services

In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined.

Development of a Resource-based Relative Value Scale and Its Conversion Factor for Advanced Nursing Practices in the National Health Insurance

PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.

Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability / 대한의료정보학회지

OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

Comparative Study of Relative Value for Diagnostic Procedure of Surgical Pathology in Korea and United States

BACKGROUND: Pathologic examination is a very important diagnostic procedure. It is the most important method to decide the therapeutic plan and to predict the prognosis of cancer patients. The Resource-Based Relative Value Scale (RBRVS) is a schema used to determine how much money medical providers should be paid. In Korea, a modified RBRVS has been used since the year 2000. METHODS: We researched the July 2010 RBRVS for Korea and the US medicare. The individual Relative Evaluation Index (REI) is defined as the ratio of an individual RBRVS to the mean RBRVS. The REIs of pathologic examination in Korea and America were compared. RESULTS: For an endoscopic biopsy specimen, the pathologic examination REI in Korea was 55.4% of the American REI. The Korean REI of a prostate biopsy (8 sites) was only 5.7% of the American REI. The Korean REI was 28.1% of the American REI for the hysterectomy for uterine myoma, and the Korean REI was 67.6% of the American REI for resection of stomach or colon cancer. CONCLUSIONS: The RBRVS of pathologic examination in Korea remains undervalued. Considering the importance of pathologic examination in medicine, the RBRVS in Korea should be increased.

Estudio descriptivo de los operadores logísticos como componentes estratégicos dentro de la cadena de valor del medicamento en Bogotá / Descriptive study about logistic operators as strategic compounds within the chain value of the drugs in Bogota

El operador logístico (ol) es una organización del sector industrial que realiza actividades complementarias como distribución, almacenamiento y transporte tanto de materias primas como de producto terminado, y su participación es cada vez más frecuente en el manejo de medicamentos, donde eventualmente pudiera verse afectada la calidad del producto. En este estudio se identificaron 75 ol localizados en la ciudad de Bogotá y se caracterizaron de acuerdo con las actividades que realizan, con el fin de determinar su importancia dentro de la cadena de valor del medicamento (cvm). Se encontró que no existen políticas exclusivas para los ol en la legislación colombiana, aunque éstos deben cumplir la normatividad existente para la manipulación de los medicamentos. En el estudio se diseñó y se desafió con el ol del sector, un instrumento especializado para capturar información que puede ser empleado en la caracterización de estas empresas en futuras investigaciones. También se identificaron nuevos servicios que los operadores ofrecen a la industria farmacéutica, corroborando el hecho de que estas organizaciones han alcanzado un importante grado de intervención sobre la cvm, especialmente conectando los eslabones productorcliente y planteando un desafío para el profesional farmacéutico en áreas alternativas de su ejercicio profesional.

The Logistic Operator (lo) is a type of industrial organization that does complementary activities such as distribution, storage and transportation, as well as, raw materials and finished products. Their interference is frequently involved in the handling of drugs and exist the risk that the quality of the drug can be affected by their participation. In this study were identified and characterized 75 (lo) located in Bogota city according to the activities that they perform, with the intention to determine their importance within the chain value of the drug (cvd). We found that don’t exist exclusive policy for lo in the Colombian legislation although they must comply with the regulations referred to handling of medicines. In this study was designed and challenged in lo of the sector, a specific document to capture information that can be use in order to get the activities of characterization in future research. Also were identified new services for the pharmaceutical industry, it was demonstrated that the (lo) possess a high degree of intervention on the cvd connecting the producer-customer links and this result expound a challenge for the pharmacist in other fields of their professional performance.

Comparison of Nursing Activity Costs of Chronic Otitis Media Surgery Patients among Time, RBRVS, and CP / 간호행정학회지

PURPOSE: The purpose of this study was to compare the cost using different methods of costing nursing activities for patients with chronic otitis media having surgery. METHOD: Data were collected from 30 patients who had mastoidectomy and tympanoplasty. To compare the cost, the researchers used three different costing methods; consumed time, resource based relative value scale (RBRVS), and critical pathway (CP). RESULTS: Twenty-six nursing activities for surgical patients with chronic otitis media were found. Total cost was 83,843.7 won using RBRVS. The costliest activity was recording at 9,734.4 won, followed by confirmation of doctors' orders at 9,302.4 won, and injection with infusion pump at 9,072.0 won. There was a difference in nursing activities performed according to the length of hospital stay, and the cost was highest on the surgery day at 13,417.8 won. Comparatively, the total cost was 72,014.4 won using CP. CONCLUSIONS: Nursing activities are performed in various forms according to the disease and patient's condition, and different nursing activities are executed according to the length of hospital stay. In order to measure the load of nursing activities and distribute it appropriately, it is necessary to analyze the cost of nursing activities by the process of nursing services performed.

Level of satisfaction with the national health insurance program in 2006 among PhilHealth accredited service providers from four medical societies

OBJECTIVES: To determine the level of satisfaction with the National Health Insurance Program (NHIP) among PhilHealth-accredited members of the four different medical societies (PCP, PPS, PCS and PSA) and identify areas for improvement of the NHIP. METHODS: In 2006, UPM-NIH conducted satisfaction surveys among PhilHealth-accredited members of the Philippine College of Physicians (PCP), Philippine Pediatric Society (PPS), Philippine College of Surgeons (PCS), and Philippine Society of Anesthesiologists (PSA) during their respective national conventions. The survey questionnaire used a Leikert scale to measure level of satisfaction and was based on the key performance areas of the NHIP identified in the validation framework of the InterAgency Validation Team and key informant interviews (KIIs) of selected medical doctors. Data analysis was done using SPSS ver 14. RESULTS AND CONCLUSION: Respondents from the PCS (surgeons) were only slightly satisfied with PhilHealth in general, while the respondents of the other three societies: (PCP - Internists, PPS - Pediatricians, and PSA - Anesthesiologists) were slightly dissatisfied with PhilHealth. Respondents of the four societies were satisfied with the accreditation process. Respondents were most dissatisfied with the length of time to be reimbursed and the amount reimbursed for their professional services. The respondents from the PCS tended to be more satisfied than the respondents of the PCP, PPS and PSA. Respondents expressed some dissatisfaction with the PhilHealth benefit package formulation. A significant percentage of respondents (about 27%) were neither satisfied nor dissatisfied with PhilHealth. These respondents could swing PhilHealth satisfaction either way and PhilHealth should make efforts to make them satisfied. The design of the survey tool precluded a qualitative analysis of the reasons for satisfaction/dissatisfaction. But the areas of most dissatisfaction identified by the respondents have to do with reimbursement: length of time and amount. In subsequent small group discussions with different physician service providers, it was observed that there was a general low level of awareness about the principles of social health insurance, benefit design and payment mechanisms. PhilHealth should address this with regular information and service improvement campaigns to engender a more proactive role for the service providers in achieving greater financial access to needed quality health services for all Filipinos. Respondents had recommendations to improve PhilHealth performance in the following areas: accreditation, reimbursement, SPECIAL ARTICLE benefit package formulation, administrative process, and coverage and enrollment. Many of the recommendations had to do with increasing PhilHealth efficiency, unifying the Department of Health (DOH), the Philippine Regulatory Commission (PRC) and PhilHealth standards, simplifying and decreasing requirements for the different processes and improving PHIC's information system. They also recommended revising the relative value scale (PhilHealth's system of assigning a value to a certain procedure which serves as the basis for determining the amount for reimbursement), improving coverage, formulating comprehensive benefit packages focused on the poor, and effective identification of the poor for the Sponsored Program, (PhilHealth's program for enrolling the poor).

Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance

PURPOSE: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. METHODS: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. RESULTS: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. CONCLUSION: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

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.

Colangiografía operatoria laparoscópica sistemática: Importancia quirúrgica y valor médico legal / Operative Colangiografía systematic laparoscópica: Surgical importance and medical legal value

El presente trabajo, relaciona dos especialidades en apariencia distintas, la Medicina Legal y la Cirugía General. Es necesario establecer criterios básicos en adelantos como la laparoscopía y nuevos aspectos medicolegales.El estudio analizado es la colangiografía operatoria. Las bases que sustentan su continuidad, están dadas en esta tesis. Se intenta apoyar su uso sistemático en toda cirugía biliar y su importancia médico legal. Muchas de las crecientes demandas por mala praxis, están relacionadas con la cirugía biliar. El objetivo principal de esta tesis, es analizar la importancia médico legal y quirúrgica de la colangiografía laparoscópica sistemática. Se compara también el método, con técnicas modernas. Se analizaron los riesgos de su uso, sus inconvenientes, su asociación entre el diagnóstico oportuno de injuria de la vía biliar con su uso sistemático. Se utilizó una casuística frondosa y rica en datos (1202 casos) de un equipo de dilatada experiencia en el tema. Esta ardua labor, permitió arribar a resultados provechosos en cuanto al uso sistemático de la colangiografía operatoria laparoscópica.Desde la óptica médico legal, se demuestra que su uso rutinario trae aparejada una sensible disminución, e incluso nula ocurrencia de injurias quirúrgicas de las vías biliares. No existe una normatización anatómica de las vías biliares que pueda brindar seguridad a la disección. Observamos un aumento inesperado de estas lesiones durante la laparoscopía. El método colangiográfico, no solo detecta modificaciones en la anatomía normal, sino también en la anatomía alterada en las litiasis complicadas. Existe una asociación entre su no realización y la ocurrencia de lesiones.

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.

Comparative analysis of functional evaluation performed in medullary injury in animals / Análise comparativa da avaliacão funcional realizada na lesão medular em animais

A avaliacão comportamental após, a contusão da medula espinhal, enfocou por um tempo a locomocão em campo aberto usando uma escala de classificacão desenvolvida por Tarlov et al.(18). Tarlov(17) realizou estudos experimentais em cães, produzindo compressão medular com atribuicão de zero a cinco para graduacão dos movimentos do animal. Contudo, esta escala tem sido modificada por pesquisadores e suas alteracões feitas por vários grupos tornaram as comparacões das medidas do resultado locomotor difíceis. Um aspecto crítico da pesquisa utilizando lesão medular em animais é a padronizacão da avaliacão da recuperacão locomotora. A escala desenvolvida por Tator(19) é simples e de fácil utilizacão, porém pode não analisar todos os aspectos necessários . Basso, Beattie e Bresnahan(2,3) apresentaram uma escala de classificacão com índice de recuperacão locomotora em ratos que sofreram lesão medular produzida em laboratório. Os dados indicam que a escala BBB é uma medida válida para a recuperacão locomotora capaz de distinguir os resultados comportamentais em funcão de ferimentos diferentes e para prever alteracões anatômicas no centro da lesão. O propósito deste estudo foi analisar e comparar escalas de classificacão locomotora sem ambigüidade, eficientes e expandida para se padronizar as medidas resultantes nos laboratórios.

Korean Resource-Based Relative Value Scale in Rheumatic Diseases / 대한류마티스학회지

In Korea, Resource-Based Relative Value Scale (RBRVS) was developed in 1997 and introduced in 2001 for the alternative of Korean Medical Fee Schedule. The RBRVS measures physician resource inputs to construct relative values for services and procedures. The RBRVS, as an administered price system, would need to be updated periodically. Changes in practice costs and practice patterns, and the rapid evolution of technology will require that relative values be adjusted over time. The Relative Value Scale Update Committee (RUC) in Korean Medical Association (KMA) is under updating annual review and 5-year review of Korean Relative Value Scale (RVS). The Korean RVS is estimated less balanced and rational in general, and furthermore there was no update after base-line study. So, it is the reason why this update of RVS is important. We, rheumatologists, are specialists for rheumatic diseases and are unfamiliar and unconcerned with health care system and medical insurance fee schedule, but this attitude is not appropriate to improve our specialized medical situation. This article reviewed the history of Korean medical insurance, development and update procedure of Korean RVS, and the current insurance problems in rheumatic diseases briefly. In Korea, RVS of medical services including rheumatology is relatively less compensated than the other invasive and imaging services. Therefore, Korean RVS update should be changed to more balanced and reasonable one for the medical service including rheumatology.