상급종합병원 심층진찰 모형개선 연구용역(시범사업 2단계 효과평가 포함)

Abstract

요약 ·············································· ⅰ 제1장 서론 1 1. 연구 배경 ············································· 3 가. 상급종합병원 심층진찰 수가 시범사업 효과 평가의 필요성 ·········· 3 나. 상급종합병원 심층진찰 수가 시범사업 고도화의 필요성 ············ 4 다. 의료기관 종별 외래 기능에 입각한 진찰료 설정의 필요성 ··········· 7 2. 연구 목적 ·············································· 8 3. 연구 내용 및 방법 ······································· 8 가. 연구 내용 ················································ 8 나. 연구 방법 ················································ 9 제2장 국내외 진찰료 현황 13 1. 우리나라 ·············································· 15 가. 진찰의 정의 및 진찰 향상을 위한 개선 뱡향 ···················· 15 나. 우리나라 기본진료료 현황 ·································· 20 2. 미국 ·················································· 28 가. 미국 Evaluation and Management (E/M) 진찰료 제도 개요 ········ 28 나. 미국 Evaluation and Management (E/M) 진찰료 제도 주요 변화 ······ 31 다. 미국 E/M 외래 진찰료 제도 현황 ···························· 32 라. 요약 및 시사점 ··········································· 36 3. 일본 ·················································· 38 가. 진찰료 기본구조 ·········································· 38 나. 기본 진료료 ············································· 38 다. 특게 진료료 ············································· 40 라. 가산 및 감액 ············································· 42 마. 일본 외래 진료수가 기본 구조와 2024년 개정 ·················· 44 4. 영국 ·················································· 55 가. 영국의 상급병원 진찰료 ···································· 55 제3장 상급종합병원 심층진찰 수가 시범사업 효과 평가 61 1. 기존 연구 평가 결과 종합 ································· 63 가. 진찰료 체계 개편을 위한 심층진찰료 도입방안 연구용역(1단계) ···· 63 나. 진찰료 체계 개편을 위한 심층진찰료 도입방안 연구용역(2단계) ···· 74 다. 상급종합병원 심층진찰 수가 시범사업 효과 분석 연구용역 ········· 99 라. 소결 ·················································· 114 2. 조사표 분석 ··········································· 118 가. 분석 방법 ·············································· 118 나. 주요 결과 ·············································· 120 다. 소결 ·················································· 146 제4장 진찰료 개편을 위한 이론적 근거 마련 149 1. 보건의료 전달체계 관련 시범사업 등 최근 동향 검토 ·········· 151 가. 협력기관 간 진료의뢰·회송 시범사업 ························· 152 나. 중증진료체계 강화 시범사업 ································ 159 다. 중증·응급 심뇌혈관질환 문제해결형 진료협력 네트워크 시범사업 ····· 165 라. 수술 전후 관리 교육상담 등 시범사업 지침 ···················· 170 마. 의료개혁특별위원회 의료개혁 실행방안 ······················· 177 바. 시사점 ················································· 181 2. 진료 유사 행위 청구 현황 검토 ··························· 183 가. 분석 방법 ············································· 183 나. 주요 결과 ·············································· 185 다. 소결 ·················································· 198 제5장 진찰료 개편 안 관련 의견 수렴 201 1. 연구 방법 및 분석 ······································ 203 가. 연구팀 구성 ············································ 203 나. 내용분석 연구방법 ······································· 203 다. 연구 참여자 선정 ········································ 204 라. 자료 수집 방법과 절차 ···································· 204 마. 분석 방법과 절차 ········································ 205 바. 윤리적 고려 ············································ 206 2. 결과 ················································· 207 가. 연구 참여자 특성 ········································ 207 나. 분석 결과 ·············································· 207 3. 소결 ················································· 222 제6장 심층진찰 시범사업 및 진찰료 개편 안 도출 223 1. 심층진찰 시범사업 개편 안 제시 ·························· 225 가. 심층진찰 시범사업의 구성요소별 개편 안 ····················· 225 나. 심층진찰 시범사업의 성과평가 안 ··························· 229 2. 소결 ················································· 232 제7장 결론 및 제언 237 1. 요약 ················································· 239 2. 제언 ················································ 241 ◾ 참고 문헌 ·········································· 243 ◾ ABSTRACT ········································ 247