Korean Journal of Occupational Therapy

Article

Occupational Therapy Medical Insurance Review of Issues and Improvement of the System in Korea

Author
송영진(Young-Jin Song), 차유진(Yu-Jin Cha)
Information
pp. 123~135 / 2015 Vol.23 No.1
e-ISSN2671-4450
p-ISSN1226-0134
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Abstract

Introduction : This study aimed to examine the current situation of the personnel and manpower of domesticoccupational therapists, the differences between occupational therapists’ duties and relevant areas defined in thelaw, the current status of the payment system of medical insurance companies for occupational therapy, and thedifferences between the current situations of the national health insurance for occupational therapy in Korea andother countries in order to analyze the problems of domestic medical insurance for occupational therapy, suggestdirections for revising the occupational therapy insurance payments, and provide foundational materials for such arevision. Results : It is necessary to cultivate manpower quantitatively, provide qualitative management, and develop aninstitutional support system through a survey on the current situation of the personnel and manpower of domesticoccupational therapists. In addition, through a comparison on the occupational therapists’ duties and relevant areasdefined in the law, this study found that it is necessary to revise the law related with the insurance systemlimiting the duties or performances of occupational therapists. Moreover, the researchers have learned thatproblems exist, resulting from the use of an academic definition of ‘occupational therapy’ as the name of thebehavior used for insurance payments, limitations on the range of duties, an imbalance among specializedtreatment areas for rehabilitation services, or an imbalance in payments of relative value. In addition, according toa comparison of the current situations of insurance payments for occupational therapy in Korea, the US, andJapan, Korea is the only country that strictly restricts the qualifications for acts of rehabilitation. Conclusion : Because insurance payments for occupational therapy do not reflect the duties of occupationaltherapists properly, it is necessary to improve the payment system based on the international standards toclassify such acts. It is expected that further legislative·institutional improvements in the domestic occupationaltherapy insurance payment system will support occupational therapists in improving national health and the qualityof life.

Keywords

보험수가 재분류 상대가치점수 작업치료 전문재활치료료 행위별 수가제 Fee for service Medical insurance reclassification Occupational therapy Relative value scale Special rehabilitation therapy