응급진료센터에서의 전산화단층촬영 - 의료보험 적용에 대한 분석 -

Abstract

A CT scan has been covered by an insurance since January 1, 1996. As a complication, it resulted in auditting many cases. The insurance lists some guidelines(approval and disapproval). In our experiences, the guidelines were not met the exact usefulness of CT and may disturb the doctor's decision for patient disposition. This study was focused on verifying the irrationality of the current guidelines. We retrospectively reviewed the charts of consecutive 189 patients who underwent CT scans during this period. The results were as follows: 1) The total cases were 228. 2) Fifty three of 228 cases were auditted. 3) Thirty four of 52 cases were brain CT scans which were taken for sudden headache (including post-traumatic headache and vertigo). Ten of 52 cases were chest CT and 4 of 10 were taken to search blebs and bullae resulting in pneumothorax. These cases can be included not only in the approval guidelines but also in the disapproval guidelines. This result indicates that approval and disapproval guidelines are inappropiate in many ways. Newer criteria should be considered to solve this confusion.