Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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A Study on the Analysis of Factors for the Increase of Oriental Medicine Expenditure in the Automobile Insurance

자동차보험 한방진료비 증가요인 분석

  • Lee, ChangSoo (Department of Statistics and Actuarial Science, Soongsil University) ;
  • Lee, Hyeon Ju (Health Insurance Review & Assessment Service) ;
  • Chae, JungMi (Health Insurance Review & Assessment Service)
  • 이창수 (숭실대학교 정보통계보험수리학과) ;
  • 이현주 (건강보험심사평가원) ;
  • 채정미 (건강보험심사평가원)
  • Received : 2018.11.05
  • Accepted : 2019.01.04
  • Published : 2019.01.31
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Abstract

Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

자동차보험 총 진료비는 2014년 대비 2015년 12% 증가하였으나 그 중 한방진료비는 36% 증가하였다. 본 연구 목적은 진료비 항등식을 이용하여 자동차보험 한방진료비의 급격한 증가 원인을 구체적으로 파악하는 것이다. 2014년~2015년 기간 중 진료하여 심사 완료된 34,351,120건의 데이터를 이용하여 분석한 결과 한방 환자수는 해당 기간 중 27%, 환자당 진료비는 7% 증가하였다. 환자당 진료비를 세분화하여 분석한 결과, 환자당 입(내)원 일수는 변하지 않았으며 일당진료비만 7% 증가하였다. 환자수 증가를 보면 한방진료만을 받은 환자는 32%, 의과와 한방을 함께 진료 받은 환자는 24% 증가한 반면 의과진료만을 받은 환자는 오히려 4% 감소하였다. 일당진료비 증가에 영향을 미치는 요인으로는 한방물리요법 등 표준화되지 않은 진료행위의 비용 상승이 있다. 그럼에도 불구하고 한방 진료비 증가에 가장 크게 영향을 미친 요인은 환자수의 증가였다.

Keywords

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Fig. 1. Distribution of oriental medicine provider

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Fig. 2. Distribution of network group of oriental medicine provider

Table 1. Medical expenses of automobile insurance by treatment type

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Table 2. Medical expenses of automobile insurance*

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Table 3. Division ratio of automobile insurance by treatment type*

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Table 4. Division ratio of oriental medicine by treatment type*

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Table 5. Number of patients* by provider type

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Table 6. Number of patients by medical treatment option*

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Table 7. Patient of oriental medicine, patient of chuna/oriental physical

SHGSCZ_2019_v20n1_121_t0007.png 이미지

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