An Analysis on Appropriateness of Health Insurance Fee Using the Activity Based Costing(ABC) Approach

활동기준 원가분석을 통한 건강보험수가의 적정성 분석

  • Kim, Han-Sung (Dept. of Healthcare Informatics, Korea Polytechnics) ;
  • Shin, Hyun-Woung (Dept. of Research Planning & Coordination, Korea Institute for Health and Social Affaire) ;
  • Cha, Jae-Young (Dept. of Publication Editorial Design, Korea Polytechnics)
  • 김한성 (한국폴리텍대학 서울강서캠퍼스 의료정보과) ;
  • 신현웅 (한국보건사회연구원 연구기획조정실) ;
  • 차재영 (한국폴리텍대학 서울강서캠퍼스 출판편집디자인과)
  • Received : 2015.08.16
  • Accepted : 2015.09.10
  • Published : 2015.09.30

Abstract

The Activity Based Costing(ABC) means the process that makes clear how the actions and input resources have changed into service to calculate medical services costs. These days, the number of hospital which is using the ABC system is increasing to make their policy decision making efficient and run the hospitals more resonable. This study analyzes the unbalance in the level of health insurance service fee and the improvement plans based from 8 hospitals(ABC system) and 95 clinics(ABC survey). The cost recovery ratio has shown different levels according to each service type. A surgery service type recorded 76.8% and an evaluation & management service type is 84.6%, a treatment procedure type(85.8%), a function test type(91.6%) and health insurance fee even did not reach to the original cost. Meanwhile, a laboratory test type and imaging test type show high level of cost recovery ratio. they recorded 188.3% and 158.8%. Resultingly now of unbalance in the level of health insurance service fee accelerates supply of every test. so there is a need to make laboratory test type and imaging test type lower to keep balance with the surgery and medical service. These methods should be performed gradually with monitoring the unbalance fee ratio and for this, a panel medical institution have to be established for generalizations of studying result, fairness of selecting researching sample.

Keywords

References

  1. American Medical Association(AMA)(2010). RBRVS Guide.
  2. Asadi MJ, Baltz WA(1996). Activity-based costing for clinical paths. An example to improve clinical cost & efficiency. Journal of Society Health System 5(2) : 1-7.
  3. Baker JJ(1998). Activity-Based Costing and Activity-Based Management for Health Care. Maryland : Aspen Publishers Inc.
  4. David TM, Harvey RO(1998). Strategic Cost Accounting Helps Create A Competitive Edge. Healthcare Financial Management 52(12) : 42-48, 50-51.
  5. Nisenbaum HL, Birnbaum BA, Myers MM, Grossman RI, Gefter WB, Langlotz CP(2000). The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method, Journal of Computer Assist Tomography 24(5) : 813-823. https://doi.org/10.1097/00004728-200009000-00026
  6. 건강보험심사평가원(2010). 건강보험요양급여비용.
  7. 건강보험심사평가원(2006) 상대가치점수 개정연구보고서.
  8. 권호근, 박은철, 신영석, 안인환, 안태식, 오동일, 이윤태, 최병호(2002). 요양기관종별 경영수지 분석자료에 의한 원가분석 연구, 서울대학교 경영연구소/연세대학교 보건정책 및 관리연구소/한국보건산업진흥원/한국보건사회연구원.
  9. 안태식, 오동일, 정형록(2005). 활동기준원가계산을 이용한 의과의원의 원가분리 및 환산지수에 관한 연구, 관리회계연구 5(1) : 57-85.
  10. 안태식, 전기홍, 김보경(1999). ABC를 이용한 병원의 진료 행위별 원가계산 : 임상병리학과의 검사별 원가계산을 중심으로, 회계학연구 24(2) : 117-140.
  11. 윤재희, 정순여, 김재열, 안상춘(2003). ABC를 이용한 병원의 원가관리 : K병원의 사례를 중심으로, 세무와 회계저널 4(1) : 295-327.
  12. 이경태, 김지홍(1997). 의료수가의 결정과 병원원가계산시스템의 분석, 회계저널 6(1) : 45-76.
  13. 이수정(2004). 활동원가계산을 이용한 가정간호 원가분석. 대한간호학회지 34(6) : 1117-1128.
  14. 이정연, 송효성(2001). 종합병원의 활동기준 원가계산제도에 관한 연구. 한국산업경제학회 14(2) : 245-259.