- Volume 26 Issue 1
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Impact of Selective Health Benefit on Medical Expenditure and Provider Behavior: Case of Gastric Cancer Surgery
선별급여 도입이 위암수술의 건강보험 진료비 및 진료행태에 미치는 영향
- Cho, Su-Jin (Health Insurance Review and Assessment Institute, Health Insurance Review and Assessment Service) ;
- Ko, Jung-Ae (Health Insurance Review and Assessment Institute, Health Insurance Review and Assessment Service) ;
- Choi, Yeonmi (Health Insurance Review and Assessment Institute, Health Insurance Review and Assessment Service)
- Received : 2016.01.27
- Accepted : 2016.03.21
- Published : 2016.03.31
Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.
Grant : 합리적 치료재료 보상을 위한 선별급여 확대방안
Supported by : 건강보험심사평가원
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