Article

Analysis of Medical Rehabilitation’s Fee Using National Health Insurance Service’s Big Data : Focusing on ICF Model

Author

차유진(Yu-Jin Cha), 송영진(Young-Jin Song), 김은영(Eun Young Kim), 김선정(Sun Jung Kim), 김동준(Dong Jun Kim)

Information

pp. 1~17 / 2017 Vol.25 No.4

Abstract

Objective: The aim of this study is to investigate how the national health insurance’s fees for services reasonably pay for the International Classification of Functioning, Disability and Health(ICF). Methods: We used data from the national health insurance service’s national sample cohort 2002–2013, which is sample of one-million people representing the entire population of health insurance beneficiaries, including medical aids. We analyzed claims for section 3: the professional rehabilitation fee under the national health insurance's fee schedule. Results: South Korea's rehabilitation fee schedule does not reflect the notion of the ICF's health and rehabilitation, which ultimately seek improving quality of life through independent living, activity/participation, and a return to society. In addition, we also found that a rehabilitation delivery system of acute-subacute(recovery)-chronic phase for efficient rehabilitation services considered base on a patient’s disease and severity has not been established in this country. Conclusion: To provide efficient and effective rehabilitation services, a rehabilitation delivery system of the acute-subacute(recovery)-chronic phase should be reformed, and the role of healthcare institutions based on a classification is also needed. Finally, for improvement and the inauguration of guideline for assessment and review, an optimum fee schedule regarding rehabilitation services should also be introduced.

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