외부병원 필름판독료 수가 개선에 따른 효과평가 연구

Abstract

As part of coverage expansion plan, the government decided to include brain-related MRI scan into the benefit package, and raised external MRI image decipher service fee for healthcare service providers in an attempt to induce appropriate level of service use. As MRI scan of spine and musculoskeletal system are planned to gradually come into national health insurance package, there is a need for a continued improvement of MRI coverage policy. To enable such improvement, this study aims to provide effectiveness assessment and suggestions for proper management measures. This study analyzed policy effectiveness of health service usage pathway before and after MRI inclusion into the benefit package of national health insurance system. Regarding analysis method, 30-day healthcare service use data of patents who received brain-related MRI scan were structured by episode and analyzed with t-test and Logit, in order to see the difference between before and after the policy implementation. The result showed that the increased decipher authority of specialist physicians led to more MRI image decipher cases of external clinics. As a result of increased MRI image decipher fee, there was an uplift of external MRI decipher cases, when compared to before the policy change. It means that more providers chose to use MRI scan taken by other clinic or hospital, rather than performing another scan at their own facility. The type of providers performing MRI scan was divided into two groups: general/tertiary hospitals, and hospitals and clinics. Policy effect was analyzed by patients' route, and it was shown that different routes had different policy effect. Based on the result, raise of MRI decipher fee was proposed for rational use pattern of healthcare resource, such as getting MRI scan with 3 Tesla MRI at a general or tertiary hospital, and visiting a hospital or clinic to get it deciphered. In order to build and operate an efficient and comprehensive healthcare resource management system, exchange of medical image data should be available more easily and conveniently. Such improvement is expected to contribute to reduction of reduced social cost and stabilization of the National Health Insurance fund.