Sung I J
Kanhohak Tamgu. 1993;2(1):68-80.
The reimbursement system for nursing services needs to be set up before beginning of the home health care system. One thing we should consider as a premise in developing a reimbursement system for home health care is that the fee-schedule of home health care should be based on the cost of unit service, since the medical reimbursement system in Korea basically depends upon the concept of 'fees for service'. A model for the development of the fee schedule was designed to make some contribution to the reimbursement system for home health care, which should be prepared before the enhancement of a new system. The model is composed of three processes as follows: cost finding of the home health care department, cost computation by service of health care, development of the fee-schedule. 1. Cost finding of the home health care department The home health care department can be defined as a major cost center producing revenues. The costs of home health care department consist of the individual costs produced in more than two departments at the same time and, therefore, should be distributed to the home health care department by certain distribution rate, and the costs which are distributed from the auxiliary departments. 2. Cost computation by service of health care The services where the costs are finally aggregated to should be defined. The direct costs which can be found by service are rendered directly to the corresponding services and the indirect costs which cannot be recognized by service should be distributed to by the distribution rate. Lastly, the costs which were passed over from the auxiliary are added to. 3. Development of the fee-schedule The costs per unit service should be transformed into the relative values. The price of the unit value is produced by dividing required revenues needed to perform the home health care activities with what aggregated relative values. The formula to produce the fees of home health care is as follows: Fi = RVi x P P = NR/sigma RVi x ni Fi: the fee of service i RVi: relative values of service i P: unit price of RV i NR: required revenues Ni: expected number of cases of service i in a year.
在家庭医疗保健系统启动之前，需要建立护理服务报销系统。在制定家庭医疗保健报销系统时，我们应作为前提考虑的一件事是，家庭医疗保健费用表应基于单位服务成本，因为韩国的医疗报销系统基本上取决于“服务收费”的概念。设计费用表制定模型是为了对家庭医疗保健报销系统做出一些贡献，该报销系统应在新系统强化之前准备好。该模型由以下三个过程组成：家庭医疗保健部门的成本核算、按医疗保健服务计算成本、费用表的制定。1. 家庭医疗保健部门的成本核算家庭医疗保健部门可被定义为产生收入的主要成本中心。家庭医疗保健部门的成本包括同时在两个以上部门产生的个别成本，因此，应按一定分配率分配到家庭医疗保健部门，以及从辅助部门分配来的成本。2. 按医疗保健服务计算成本应确定最终汇总成本的服务。可按服务找到的直接成本直接提供给相应服务，无法按服务确认的间接成本应按分配率进行分配。最后，加上从辅助部门结转的成本。3. 费用表的制定单位服务成本应转换为相对值。单位价值的价格是通过将开展家庭医疗保健活动所需的所需收入除以汇总的相对值得出的。家庭医疗保健费用的计算公式如下：Fi = RVi x P P = NR / sigma RVi x ni Fi：服务i的费用 RVi：服务i的相对值 P：RV i的单位价格 NR：所需收入 Ni：一年中服务i的预期病例数
