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가정간호수가제도의 도입을 위해서는 이를 뒷받침할 의료수가가 구비되어야 한다. 현재으 행위별수가제도 하에서 가정간호수가는 행위별원가를 근거로 하여 설정되는 것이 바람직한다. 본고에서는 가정간호서비스에 대하여 행위별원가계산 및 수가산정모델을 제시하였다. 가정간호서비스별로 배분하여 산정되며, 이를 다시 현행 의료보험수가체계에 맞도록 재구성하여 기술료, 재료대, 기본진료료 등의 원가를 구한다. 가정간호수가는 가정간호사업을 통하여 확보해야 할 필요수익을 기간 중 예상되는 가정간호행위별 상대치의 적수로 나누어 산출한 상대치단위당 금액에 행위별 상대치를 곱하여 산정한다.
The reimbursement system for nursing services needs to be set up before beginning of the home health care system. One thing we should consider as a premise in developing a reimbursement system for home health care is that the fee-schedule of home health care should be based on the cost of unit service, since the medical reimbursement system in Korea basically depends upon the concept of `fees for service´.
A model for the development of the fee schedule was designed to make some contribution to the reimbursement system for home health care, which should be prepared before the enhancement of a new system. The model is composed of three processes as follows: cost finding of the home health care department, cost computation by service of health care, development of the fee-schedule.
1. Cost finding of the home health care department
The home health care department can be defined as a major cost center producing revenues. The costs of home health care department consist of the individual costs produced in more than two departments at the same time and, therefore, should be distrib-
uted to the home health care department by certain distribution rate, and the costs
which are distributed from the auxiliary departments. I- I
2. Cost computation by service of health care
The services where the costs are finally aggregated to should be defined. The direct costs which can be found by service are rendered directly to the corresponding services and the indirect costs which cannot be recognized by service should be distributed to by the distribution rate. Lastly, the costs which were passed over from the auxiliary are added to.
3. Development of the fee-schedule
The costs per unit service should be transformed into the relative values. The price of the unit value is produced by deviding required revenues needed to perform the home health care activities with wht aggregated relative values. The formula to produce the fees of home health care is as follows:
Fi=RVi x P
P = NR/RVi x ni
Fi : the fee of service i
RVi : relative values of service i
P : unit price of RV i
NR : required revenues
Ni : expected number of cases of service i in a year
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