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병원특성이 의료보험 진료비심사 조정액에 미치는 영향

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dc.contributor.author장영희-
dc.date.accessioned2015-11-20T05:24:11Z-
dc.date.available2015-11-20T05:24:11Z-
dc.date.issued1991-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/116823-
dc.description보건학과/석사-
dc.description.abstract[한글] 의료보험진료비 조정건율과 조정금액률을 진료항목별, 조정사유별로 나누어 병원특성에 따라 차이가 있는지를 분석하며 병원특성의 어떠한 요인이 병원의 조정건율과 조정금액률에 영향을 미치는지를 알아보고자 1990년 1월1일부터 6월30일가지 직장의료보험 피보험 자 대상의 종합병원 입원건 305,780건을 해당 종합병원별로 조정내역을 세분화하여 자료를 이용하였고 의료기관 특성별로 병상수, 설립구분, 소재지, 의료보험담당 간호사수, 수련병원 유무, 전산청구 유무를 조사하여 연구자료를 이용 분석하여 다음과 같은 결과를 얻었다. 종합병원급의 심사조정건율은 54%에 이르며, 심사조정금액률은 청구진료비의 2% 수준이다. 의료기관 특성별로 심사조정현황은 설립구분별로 국·공립, 사립대학병원의 조정건율, 조정금액률, 조정건당조정금액이 모두 높았고 병상수도 500병상이상급 의료기관의 경우도 위 세지표가 모두 높게 나타났다. 중회귀분석결과 조정건율에서는 설립구분(국·공립), 설립구분(사립대학)이 양의 관계를 갖고 소재지(대도시)는 음의 관계를 갖는다. 조정금액률과 양의 관계를 갖는 변수들로는 설립구분(국·공립)이고 음의 관계를 갖는 변수들로는 보험담당간호사이다. [영문] This study is design to analyze the rate of the adjusted cases and medical expenses by care items and adjustment causes in the medical insurance bills reviewed by National Federation of Medical Insurance in order to find out whether there were differences among the characteristics of medical institutions and, if so, which characteristics could affect the rate. For this analysis, the 305,780 cases of inpatient care were used and classified in datails by the characteristics of medical institutions, and the variables, like number of beds, foundation form, site, number of nurses in charge of medical insurance, apprentice hospital or not, fee claim by computer system or not, were considered. The results are as follows. The rate of adjusted cases attains to 54% and the rate of adjusted amount 2% of total claims requested in general hospitals. In the perspective of hospital characteristics, the adjustment case rate, the adjustment expenses rate and the adjusted amount per adjusted case present all high figures in every university hospitals whether it is national & public hospitals or private hospitals, and the medical institution with over 500 beds, too. The results of multiple regression shows that the rate of the adjusted cases has some positive correlation with the foundation from (national & public, private), in the other hand some negative correlation with the site(large city). And the rate of the adjusted amount has positive correlation with the foundation form(national & public), whereas negative correlation with the number of nurses in charge of medical insurance.-
dc.description.statementOfResponsibilityrestriction-
dc.publisher연세대학교 보건대학원-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.title병원특성이 의료보험 진료비심사 조정액에 미치는 영향-
dc.title.alternative(The) performance of reviewing the medical insurance bills and it's relations with the hospital characteristics-
dc.typeThesis-
dc.identifier.urlhttps://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000005340-
dc.contributor.alternativeNameChang, Young Hee-
dc.type.localThesis-
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 2. Thesis

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