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방은주 ( Bang Eun-Joo ) - 서울대학교 간호대학 간호학과
최은숙 ( Choi Eun-Sook ) - 경북대학교 간호대학 간호학과
고영 ( Ko Young ) - 국민건강보험공단
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Abstract
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Purpose: The objectives for this study are to produce the comprehensive management indexes and find their application strategies for appropriate medical care in primary care clinics under workers’ compensation insurance.
Method: Data of this study was workers’ compensation insurance medical fees claim’s data from July 2006 to June 2007. Data were analyzed using SAS 9.1 version by applying descriptive statistics and Pearson’s correlation.
The indexes such as costliness index(CI), standard medical fee were calculated based on the fourth revision of korean classification of diseases(KCD-4.).
Results: The CI, visiting index(VI), outliers index(OI), and medical review adjustment percentage were positively
correlated in the both inpatient and outpatient medical fees in primary care clinics under workers’ compensation insurance. The major medical specialities were neurological surgery, general medicine, general surgery, rehabitational medicine, and orthopedic surgery. The CIs were slightly high in rehabitational medicine among major medical specialities. The CIs were mostly high in diagnosis, test, anesthesia, and rehabitational assistive device fees among major medical specialities. The CIs were slightly high in Kwangju, Daegu, Daejeon, and Busan districts among district management centers of Korea Workers’ Compensation and Welfare Service.
Conclusions: We suggest the continuous development of appropriate disease classification system and medical care quality indicators to successfully take root the comprehensive management for appropriate medical care under workers’ compensation,
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KeyWords
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산업재해, 근로자 보상, 의료비용
Industrial accident, Workers compensation, Medical care costs
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원문 및 링크아웃 정보
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등재저널 정보
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