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자율형 분석심사 선도사업 효과분석 및 모형개선 연구(요약보고서)

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Type
Research report
Author(s)
윤석준이요한최민재이은해진달래SEMPUNGU JOSHUA KIBARO허륜성지원박기선
Issued Date
2023-09
Keyword
자율형 분석심사ARIMADID문헌고찰참여기관 심층인터뷰
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3230
Table Of Contents
제1장 서론 ·············································· 3
1. 연구배경 및 목적 ··················································································· 3
가. 연구배경 및 필요성 ···················································································· 3
나. 연구 목적 및 목표 ······················································································ 5
2. 연구내용 및 방법 ··················································································· 6
가. 연구내용 ···································································································· 6
나. 연구방법 ···································································································· 7

제2장 자율형 분석심사 선도사업의 정량적 효과 도출 ·············································· 10
1. 자율형 분석심사 선도사업 경과 및 효과분석 개요 ···································· 10
가. 자율형 분석심사 선도사업 대상 영역 및 참여기관 현황 ································ 10
2. 자율형 분석심사 선도사업 정책효과 분석 ················································ 10
가. 참여기관의 자율형 선도사업 도입 전/후 비교(시계열적 분석 : ARIMA 모형) ·· 10
나. 대조군 구성을 통한 진료행태의 비교 및 제도 도입 효과분석(PSM, DID 분석) ···· 13
3. 뇌졸중 영역 정책효과 분석 결과 ···························································· 14
가. 뇌졸중 영역 자율형 분석심사 선도사업 도입 전/후 분석 (ARIMA 모형) ········ 14
나. 뇌졸중 영역 효율성 지표 분석 (대조군 설정 분석) ·········································· 16
4. 중증외상 영역 정책효과 분석 결과 ························································· 17
가. 중증외상 영역 자율형 분석심사 선도사업 도입 전/후 분석 (ARIMA 모형) ····· 17
나. 중증외상 영역 효율성 지표 분석 결과(대조군 설정 분석) ······························ 19
5. 정량적 분석 소결 ················································································· 20

제3장 자율형 분석심사 모형개선을 위한 정성적 분석 ·············································· 22
1. 현행 자율형 분석심사 선도사업 현황 및 문제점 도출 ······························· 22
가. 정성적 분석 방법론 ·················································································· 22
나. 자율형 분석심사 참여 주체별 의견수렴 및 분석 결과 ··································· 22
2. 질적 분석을 통한 선도사업 개선사항 도출 ·············································· 27
가. 자율형 분석심사 선도사업을 통한 건강보험심사평가원-요양기관 상호 부담 경감(Win-Win) 27
나. 자율형 분석심사의 운영 방향성 및 계획 확립 ·············································· 27
다. 자율형 분석심사를 활성화를 통한 임상현장의 상호 신뢰 및 이해도 제고 ········ 28
라. 자율형 분석심사를 통한 지속가능한 심사제도 확립 ······································· 28

제4장 자율형 분석심사 선도사업 개선 방향 마련 ·············································· 29
1. 자율형 분석심사 선도사업 운영모형 개선방안 ·········································· 29
가. 자율형 분석심사 선도사업 내 활용되는 지표 개념 확립 ································ 29
나. 자율형 분석심사 신규 발굴 질환의 기준 ····················································· 31
다. 기존 대상 질환 영역 내 확대 기준 및 개선방안 ·········································· 33
2. 연구의 결론(Conclusion) : 자율형 분석심사 선도사업 운영 방향성 확립 ······ 35
가. 요양기관 이해도 제고 및 참여 활성화 전략 ················································· 35
나. 임상 현장 신뢰 관계 및 협업체계 구축 전략 ················································· 35
다. 자율형 분석심사를 통한 의료의 질과 효율성 관리 ········································ 36
2. 정책적 제언 : 선도사업 운영을 위한 단계별 점검 사항 ······························· 37
가. 자율형 분석심사 선도사업 활성화를 위한 단기 개선과제 ······························· 37
나. 자율형 분석심사 선도사업 활성화를 위한 중장기 개선과제 ···························· 38
Publisher
건강보험심사평가원
Location
KOR
Citation
윤석준. (2023-09). 자율형 분석심사 선도사업 효과분석 및 모형개선 연구(요약보고서).
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