산재보험지정의원 요양급여적정성 종합관리지표 산출 및 적용방안

• 영문명: The Comprehensive Management Indexes and Their Application Strategies for Appropriate Medical Care in Primary Care Clinics Under Workers Compensation Insurance
• 발행기관: 한국직업건강간호학회
• 저자명: 방은주(Bang, Eun Ju) 최은숙(Choi, Eun Sook) 고영(Ko, Young)
• 간행물 정보: 『한국직업건강간호학회지』제17권 제1호, 86~95쪽, 전체 10쪽
• 주제분류: 의약학 > 간호학
• 파일형태: PDF
• 발행일자: 2008.05.31

영문 초록

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,

목차

Ⅰ. 서론

Ⅱ. 연구 방법

Ⅲ. 연구 결과

Ⅳ. 논의

Ⅴ. 결론 및 제언

키워드

산업재해 근로자 보상 의료비용 Industrial accident Workers compensation Medical care costs