外來多頻度傷病의 診療科目別 診療費에 關한 硏究 = Outpatient Cost Variations in the Twelve Most Frequent Diseases Among Practicing Physicians of Various Medical Specialities

다국어 초록 (Multilingual Abstract)

This study was intended to identify cost variations among various medical specialities under the fee-for-service system of health insurance remuneration. In order to achieve the objective, 16,239 samples were drawn from health insurance claim sheets made during the period of one month, February, 1990 on the basis of systematic random sample technique. The twelve most frequent diseases were chosen from the record of the 1988 health insurance statistics. They were upper respiratory infection and its related diseases, bronchitis and related diseases, gastritis and duodenitis, conjunctival diseases, joint diseases, contact dermatitis and eczema, female genital inflammatory diseases, lumbago, neurosis, peptic ulcer, gastroenteritis, and nonspecific enteritis.
There were enormous interspeciality cost variations as expected. For example, the outpatient expense for upper respiratory infection was highest in the speciality of ENT, 12,675 won per claim, which was 1.8 times higher than that of neurosurgery, 6,952 won. In general, the proportion of drugs expense also showed extreme variations among medical specialities. One of the most conspicuous findings for the cost of drug was obtained from the outpatient expense for the gastritis and duodenitis: the drug expense amounted to 4,035 won in the case of general practitioner, which was 5.2 times more than that of orthopedic surgery. Similar findings were noted for technical fees and basic fees.
In addition to the above cost variations, this study showed that the outpatient care by general practitioners was proven to be not that cheap, compared to the other medical specialities. This was mainly due to more frequent visits by patients in the case of general practitioners.
However, the above findings need to be elaborated through taking account of various characteristics of medical providers such as age, sex, and those of case mix. Further study is called for to confirm the findings.
Anyway, this study suggests that some changes in payment method are urgently needed to make remedies in the current unjustfiable cost variations among medical specialities.