비용기반 포괄수가 조정방안
- Type
- Research report
- Issued Date
- 2022-12
- Publisher
- 건강보험심사평가원
- Table Of Contents
- 요약 ···························································································· ⅰ
제1장 서론 1
1. 연구배경 및 목적 ····················································································· 2
가. 연구배경 ······································································································ 2
나. 연구목적 ······································································································ 8
2. 연구내용 및 방법 ····················································································· 8
가. 연구의 틀 ···································································································· 8
나. 연구 내용 ···································································································· 9
다. 연구 방법 ·································································································· 12
제2장 국내 및 국외 포괄수가 고찰 및 문헌검토 17
1. 국내 포괄수가 ························································································ 18
가. 비용(원가) 기반의 포괄수가 산출 방식 ·························································· 18
나. 비용(원가) 기반 포괄수가 조정방안 검토 ······················································· 20
다. 현행 포괄수가 산출 시 사용된 자료원 검토 ··················································· 23
라. 비용(원가) 기반 포괄수가 개편 이후 별도보상 적용 ········································ 24
2. 국외 포괄수가 현황 ················································································ 25
가. 미국 ·········································································································· 25
나. 독일 ·········································································································· 30
제3장 포괄수가 산출자료의 적정성 검토 및 원가보전율 산출 35
1. 원가자료 검토 ························································································ 36
가. 의료기관 비용자료 ······················································································ 36
2. 진료내역자료 수집 결과 ·········································································· 47
가. 원가보전율 산출 ························································································· 47
나. 공공･민간별, 지역별 및 종별 원가보전율 비교 ··············································· 51
다. 비용자료 적정성 검토 ·················································································· 60
제4장 포괄수가 산출방식 63
1. 중증도 0수가 결정 ················································································· 64
가. 진료내역 원가추정 방식-기존방식 ································································· 64
나. 진료내역 원가추정 방식-개선방안 1 ····························································· 66
다. 진료내역 원가추정 방식-개선방안 2 ····························································· 73
라. 진료내역 원가추정 방식-개선방안 3 ····························································· 80
마. 중증도 0 기준수가 결정 ·············································································· 89
2. 중증도 1-3 수가 결정 ············································································ 95
제5장 진료효율화 관련 대조정 방안 101
1. 진료효율화에 대한 적정보상 관련 적용방안 ············································· 102
가. 진료효율화 기준 ······················································································· 102
나. 진료효율화 평가기준 산출과정 ···································································· 104
2. 진료효율화에 따른 적정보상 및 시뮬레이션 ············································· 107
가. 진료효율화에 따른 적정보상 적용 시뮬레이션 ·············································· 107
제6장 연차별 조정 방안 125
1. 연차별 수가조정 관련 적용방안 ······························································ 126
가. 의료경제지수(MEI, Medical Economic Index) 적용 ··································· 126
2. 연차별 수가조정 시뮬레이션 ·································································· 129
가. MEI 산출안 ····························································································· 129
나. MEI 적용 수가 시뮬레이션 ········································································ 134
제7장 연구 조정모델 반영을 위한 운영방식 고찰 및 제언 135
1. 행위별 수가제와 독립된 포괄수가 운영을 위한 방향 ································· 136
가. 현행 포괄수가제 근거법령 ·········································································· 136
나. 현행 비용(원가) 기반 포괄수가제와 관련된 법령의 개선점 ····························· 139
다. 환산지수를 사용하여 포괄수가 조정기전을 유지할 경우 개선방향 ··················· 139
라. 환산지수 외 기전(MEI 등)을 통해 포괄수가를 조정할 경우 개선방향 ············· 140
2. 수가조정 업무 프로세스 ········································································ 143
3. 별도보상 운영방안 관련 사항 ································································· 144
가. 별도보상의 기준에 관한 제언 ····································································· 144
나. 별도보상 운영방안 검토 ············································································· 145
제8장 결론 147
1. 종합 및 제언 ····················································································· 148
부록 ······························································································ 155
참고 문헌 ······················································································ 170
- Publisher
- 건강보험심사평가원
- Location
- KOR
- Citation
- 박은철. (2022-12). 비용기반 포괄수가 조정방안.
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