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자율형 분석심사 선도사업 효과분석 및 모형개선 연구(최종보고서)

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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/3231
Table Of Contents
제1장 서론 ·························································· 1
1. 연구배경 및 목적 ··················································································· 3
가. 연구배경 및 필요성 ···················································································· 3
나. 연구 목적 및 목표 ···················································································· 13
2. 연구내용 및 방법 ················································································· 14
가. 연구내용 ·································································································· 14
나. 연구방법 ·································································································· 15

제2장 자율형 분석심사의 정량적 효과 도출 ·························································· 27
1. 자율형 분석심사 선도사업 경과 및 효과분석 개요 ···································· 29
가. 자율형 분석심사 선도사업 대상 영역 및 참여기관 현황 ································ 29
나. 자율형 분석심사 선도사업 대상 영역별 연간 진료 현황 ································ 30
2. 자율형 분석심사 선도사업 정책효과 분석 ················································ 32
가. 참여기관의 자율형 선도사업 도입 전/후 비교(시계열적 분석 : ARIMA 모형) ·· 32
나. 대조군 구성을 통한 진료행태의 비교 및 제도 도입 효과 분석(PSM, DID 분석) ·· 37
3. 뇌졸중 영역 정책효과 분석 결과 ···························································· 40
가. 뇌졸중 영역 자율형 분석심사 선도사업 도입 전/후 분석(ARIMA 모형) ·········· 40
나. 뇌졸중 영역 의료 질 지표 분석 : 대조군 구성을 통한 효과 분석 결과(PSM/DID) ·· 59
4. 중증 외상 영역 자율형 분석심사 선도사업 정책효과 분석 결과 ················· 78
가. 중증외상 영역 자율형 분석심사 선도사업 도입 전/후 분석(ARIMA) ··············· 78
나. 중증외상 영역 효율성 지표 분석 결과(대조군 설정 분석) ······························ 93
다. 중증외상 영역 의료 질 지표 진료성과 지표 분석 ······································ 105
5. 정량적 분석 소결 ················································································ 110

제3장 자율형 분석심사 모형개선을 위한 정성적 분석 ·························································· 113
1. 국내외사례 및 문헌 고찰을 통한 개선사항 도출 ····································· 115
가. 의료 질 관리(Quality Assurance) 관련 문헌 고찰 ···························· 115
나. 미국의 기관 단위 표본 심사 ···································································· 121
다. 호주의 외래진료비 심사체계 및 메디케어 준수 프로그램 ····························· 123
라. 대만의 기관 단위 표본심사 사례 ······························································ 125
2. 현행 자율형 분석심사 선도사업 현황 및 문제점 도출 ····························· 126
가. 정성적 분석 방법론 ················································································· 126
나. 자율형 분석심사 참여 주체별 의견 수렴 및 분석 결과 ································ 128

제4장 자율형 분석심사 선도사업 개선 방향 마련 ·························································· 141
1. 자율형 분석심사 선도사업 운영모형 개선방안 ········································ 143
가. 자율형 분석심사 선도사업 내 활용되는 지표 개념 확립 ······························ 143
나. 자율형 분석심사 신규 발굴 질환의 기준 ···················································· 150
다. 기존 대상 질환 영역 내 확대 기준 및 개선방안 ········································ 154
2. 연구의 결론 및 제언 ··········································································· 157
가. 제한점(limitations) ················································································· 157
나. 연구의 결론(Conclusion) : 자율형 분석심사 선도사업 운영 방향성 확립 필요 ·· 159
다. 정책적 제언 : 선도사업 운영을 위한 단계별 점검 사항 ······························ 163

◾ 참고 문헌 ····················································································· 169
◾ 부록 ····························································································· 172
Publisher
건강보험심사평가원
Location
KOR
Citation
윤석준. (2023-09). 자율형 분석심사 선도사업 효과분석 및 모형개선 연구(최종보고서).
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