Estimation of insurance reimbursement rate using meta analysis : education program for children/families with asthma
Dept. of Nursing/박사
The main purpose of this study was to present a method to estimate insurance reimbursement rate using meta analysis to assess the effect size of education program for asthmatic children. This study only estimated the direct medical expense savings that could be decreased by applying the effect size of the education program to actual health insurance claims data. Literatures were selected from 8 domestic databases including Koreamed and the international databases such as Ovid-MEDLINE and EMBASE. The outcome variables include; emergency room visit rate, hospitalization rate, inhalant prescription days, pulmonary function, days of limited activity, and quality of life, etc. A total of 1,903 literatures were identified initially, but they were filtered according to the researcher’s selection/exclusion criteria and 26 studies were included in the final analysis. RevMan5.0 was used for meta-analysis. Through verification of homogeneity for each study, a fixed effect model was used in general; in case of heterogeneity among the literature, a random effect model was used. Risk ratio(RR) was presented for dichotomous outcome variables; weighted mean difference(WMD)/standard mean difference(SMD) and 95% confidence interval(CI) were presented for continuous variables and the inverse variance method was used. As result of meta-analysis, the variables related with direct medical expense are a number of ER visit/patient (32% decrease), days of ER visit (0.3 days decrease), days of hospitalization (0.01 days decrease), days of inhalant prescription (0.22days decrease), and number of inhalant prescribed patienst (18% decrease) when they had education on asthma. Direct medical expense savings was calculated by applying the above data to the Heatlh Insurance Review & Assessment for 2009 of patients under the age of 18 with asthma or status asthmaticus (KCD J45, J46). In result, out of the annual sum of emergency room fee of ₩542,315,090 approximately ₩173,540,829, out of the annual sum of emergency demanded payment of ₩1,618,362,478 approximately ₩490,917,705, out of the annual sum of hospitalization fee of ₩19,264,706,870 approximately ₩490,917,705, out of the annual sum of inhalant prescription fee of ₩983,183,553 approximately ₩154,436,998 and ₩176,973,040 can be saved according to the decrease of ER patients, ER visits, days of hospitalization, days of prescription, and number of patients, respectively. Thus, decrease in annual medical costs, which may reflect the effects of education estimated by the meta-analysis for each item, was predicted to be approximately ₩2.9 billion. This is approximately 2.2% of annual medical expenses (₩129 billion) for asthmatic children. Assuming decreased costs would be used to compensate for the educational programs based on the principle of financial neutrality, per capita costs for this education can be estimated at ₩2,324. However, this is only the direct medical cost which did not include school absence, parents’ missing work, quality of life, etc. Since many chronic illnesses require education for patients and families to improve self care and compliance, more research is required in developing, implementing, and evaluation of the education program. Furthermore, more researches in estimation of insurance reimbursement rate to strengthen the policy.