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김진현 ( Kim Jin-Hyun ) - 서울대학교 간호대학
정유미 ( Jung Yoo-Mi ) - 서울대학교 간호대학
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Abstract
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Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife’s delivery services in the national health insurance and estimated the optimal reimbursement level for the services.
Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife’s services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis.
Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase,
respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife’s services.
Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife’s services could be an opportunity as well as a challenge when it comes to efficient resource allocation.
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KeyWords
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환산지수, 간호수가, 조산원, 건강보험
Conversion factor, Nurse fee, Nurse-midwife, Reimbursement
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원문 및 링크아웃 정보
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등재저널 정보
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