Cited 0 times in Scipus Cited Count

Trauma surgery without proper compensation under the current Korean National Health Insurance System

Jung, K  | Heo, Y  | Lee, JC  | Lee, M  | Son, S | Park, HS | Kim, JO | Lee, JH
Annals of surgical treatment and research, 92(5). : 370-375, 2017
Journal Title
Annals of surgical treatment and research
PURPOSE: This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries.
METHODS: We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings.
RESULTS: During the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed: however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA: 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was "fee criteria and limited number". The compensation rate for billed surgical procedures was 84.5%.
CONCLUSION: The high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.

Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Medical Humanities & Social Medicine
Ajou Authors
이, 국종  |  이, 미진  |  정, 경원  |  허, 윤정
Full Text Link
Files in This Item:


해당 아이템을 이메일로 공유하기 원하시면 인증을 거치시기 바랍니다.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.