Journal of dental hygiene science (치위생과학회지)

The Korean Society of Dental Hygiene Science (한국치위생과학회)
권호 표지
DOI QR코드

DOI QR Code

Factors Influencing the Knowledge of Health Insurance Standard and Health Insurance Application

요양급여비용 산정기준의 지식수준과 건강보험 실무적용에 영향을 미치는 요인

  • Lee, Soon-Young (Department of Dental Hygiene, Graduate School, Namseoul University) ;
  • Lim, Soon-Ryun (Department of Dental Hygiene, Namseoul University)
  • 이순영 (남서울대학교 일반대학원 치위생학과) ;
  • 임순연 (남서울대학교 치위생학과)
  • Received : 2015.11.02
  • Accepted : 2015.11.26
  • Published : 2015.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

This study aims to figure out the current state of health insurance education provided to dentists and personnel in charge of insurance claim as well as the effects of experiences in education on their knowledge of health insurance standard and actual application. As a result of analysis on 100 data sheets related to dentistry and 100 data sheets related to personnel in charge of insurance claim (a total of 200 data sheets), following results were generated. Insurance claim personnels showed higher score than dentist in knowledge of health insurance standard and it was significant statistically. Knowledge of insurance claim personnel showed significant differences in educational experiences, in health insurance for the latest three years and average hours of education per session whereas that of dentists did not indicate any significant differences. The level of practical application of dentists was significantly different (p<0.05) according to experiences in insurance claim, and that of insurance claim personnel significantly varied (p<0.05) depending on age, experiences of insurance education and average hours of education. The longer average hours of education, the higher level of practical application. Experiences of insurance education turned out to affect on the knowledge of health insurance standard significantly (p<0.05) on the part of dentists and insurance claim personnel, and the level of experiences in insurance claim and knowledge of health insurance standard on the part of dentists and insurance claim personnel turned out to affect on practical application significantly (p<0.001). Judging from the result, continuous education needs to be conducted in order to enable dentists and insurance claim personnel to maintain the level of knowledge about health insurance and practical application.

이번 연구는 임상에 근무하고 있는 치과의사와 보험청구 담당자들의 건강보험관련 교육의 참여 실태를 파악하고, 교육경험이 그들의 요양급여비용의 산정기준에 대한 지식과 건강보험 실무 적용수준에 미치는 영향을 파악하고자 전국에 소재한 치과 병 의원에 근무하는 치과의사와 보험청구 담당자를 대상으로 설문 후 분석한 결과 다음과 같은 결론을 얻었다. 요양급여비용 산정기준에 관한 지식수준은 보험청구 담당자가 치과의사보다 높은 것으로 나타났다(p<0.01). 교육참여 횟수가 많을수록 보험청구 담당자의 요양급여비용 산정기준 지식수준이 통계적으로도 유의하게 높은 것으로 나타났고(p<0.001), 평균교육시간이 3시간 미만인 경우보다 3시간 이상인 경우 요양급여비용 산정기준에 대한 지식수준이 높게 나타났고, 통계적으로 유의한 차이를 보였다(p<0.05). 보험청구 담당자가 치과의사보다 건강보험 실무적용수준이 높은 것으로 나타났고, 통계적으로 유의한 차이를 보였다(p<0.001). 치과의사는 보험청구 경력이 많을수록 건강보험 실무 적용수준이 높은 것으로 나타났고(p<0.01), 보험청구 담당자는 연령이 적을수록, 교육 참여 횟수가 많을수록, 평균교육 시간이 길수록 건강보험 실무 적용수준이 높은 것으로 나타났다(p<0.05) 최근 3년간 건강보험관련 교육의 참여경험이 보험청구 담당자의 요양급여비용 산정기준 지식수준에 유의한 영향을 미치는 요인으로 나타났고(p<0.001), 보험청구 경력과 요양급여비용 산정기준 지식수준은 그들의 건강보험 실무 적용수준에 유의한 영향을 미치는 것으로 나타났다(p<0.01) 이러한 결과로 미루어볼 때 치과의사 및 보험청구 담당자의 건강보험에 관한 지식수준과 건강보험 실무적용 수준을 유지하기 위해서는 관련된 교육 관련된 교육을 지속적으로 받는 것이 필요할 것으로 판단된다.

Keywords

References

  1. National Legal Information Center: National Health Insurance Act. Retrieved November 19, 2015, from http://law.go.kr/lsSc.do?menuId=0&p1=&subMenu=1&nwYn=1§ion=&tabNo=&query=%EA%B5%AD%EB%AF%BC%EA%B1%B4%EA%B0%95%EB%B3%B4%ED%97%98%EB%B2%95#undefined.(Enforcement date, November 21, 2014).
  2. Health Insurance Review & Assessment Service: fee-forservice. Retrieved November 19, 2015, from http://www.hira.or.kr/dummy.do?pgmid=HIRAA020024000000&cmsurl=/cms/law/02/01/04/02/payment_type.html.
  3. Moon HR: A survey on health insurance claims and knowledge by the hygienist in Jeollabuk-do. Unpublished master's thesis, Wonkwang University, Iksan, 2013.
  4. Chang YS, Ahn YW, Park JS, Ko MY: Dentists' opinions in the dental field of present health insurance claim and review. J Oral Med Pain 30: 215-230, 2005.
  5. Nam YO, Kim SH, Kim MJ: The investigation of the degree of the request of the education about the claim for the medical expenses in the dentistry health insurance-mainly in the Daejeon, Chungcheong area. J Korean Soc Dent Hyg 11: 325-341, 2011.
  6. Kim KH: A study on the survey of oral health insurance benefit by dental hygienist on the aspect of periodontal treatment. Unpublished master's thesis, Chosun University, Gwangju, 2004.
  7. Kim SH. Kim MJ, Nam YO: Analysis research about awareness of demanders of recuperation allowance for dental clinic health insurance in Daejun and Chunchung area. J Korean Soc Dent Hyg 11: 275-289, 2011.
  8. Song JP: Effects of self-efficacy on knowledge of health insurance guidelines in dental clinic. Unpublished master's thesis, Kosin University, Busan, 2013.
  9. Yoo EM, Ahn SY, Choi HS, Hwang SH, Oh BK: A study on the state of the claim of dental medical institutions for payment from the national health insurance corporation. J Dent Hyg Sci 11: 31-35, 2011.
  10. Kim HS: Awareness of dental institution employees in charge of health insurance claim on health insurance and related education in Jeollabuk-do. Unpublished master's thesis, Wonkwang University, Iksan, 2014.
  11. Han HJ, Kim YS: A study on awareness of the dental health insurance coverage. J Dent Hyg Sci 8: 65-71, 2008.
  12. Kim KM, Ma DS, Jung SH, Kim CS, Park DY: Education on national health insurance: experience of Korean dentists who secured a license during 2000-2004. J Korean Acad Oral Health 38: 25-30, 2014. https://doi.org/10.11149/jkaoh.2014.38.1.25
  13. Kwon JH, Lee MH, Yang JK, et al.: The research on the actual condition of health insurance education in the course of advanced general dentistry (AGD). J Korean Acad Dent Insurance 2: 1-14, 2011.
  14. Kim JB, Jung SH, Yang JK: Education related to the national health insurance at dental colleges and graduate schools of dentistry in Korea. J Korean Acad Dent Insurance 1: 8-16, 2010.
  15. Hong SA: A survey on health insurance claim affairs among dental clinic. Unpublished master's thesis, Inje University, Gimhae, 2010.
  16. Kim KH: A study on recognition and application degrees of clinical nurses' health insurance charge standard. Unpublished master's thesis, Kyunghee University, Seoul, 2002.
  17. Ju OJ, Kang EJ, Woo SH, Lee AJ, Lee HJ, Park MY: Recognition between lay persons and dental hygienists on expansion of health insurance of scaling. J Dent Hyg Sci 14: 431-438, 2014