보건행정학회지 (Health Policy and Management)

  • 제19권3호
  • /
  • Pages.109-124
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  • 2009
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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건강보험 현지조사제도에서 일반적 억제이론에 대한 경험적 연구

An Empirical Study on General Deterrence Effects of the On-site Investigation System in the Korean National Health Insurance

  • 강희정 (건강보험심사평가원 심사평가정책연구소) ;
  • 홍재석 (건강보험심사평가원 심사평가정책연구소) ;
  • 김세라 (건강보험심사평가원 심사평가정책연구소) ;
  • 최지숙 (건강보험심사평가원 심사평가정책연구소)
  • Kang, Hee-Chung (Health Insurance Review & Assessment Service, Health Insurance Review & Assessment Policy Institute) ;
  • Hong, Jae-Seok (Health Insurance Review & Assessment Service, Health Insurance Review & Assessment Policy Institute) ;
  • Kim, Se-Ra (Health Insurance Review & Assessment Service, Health Insurance Review & Assessment Policy Institute) ;
  • Choi, Jee-Sook (Health Insurance Review & Assessment Service, Health Insurance Review & Assessment Policy Institute)
  • 발행 : 2009.09.30
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초록

Background: This study aimed to examine whether cases of punishing false claimants threat general physicians to check their medical cost claims with care to avoid being suspected, and identify empirically general deterrence effects of the on-site investigation system in the Korean National Health Insurance. Methods: 800 clinics were selected among a total of 15,443 clinics that had no experience of on-site investigation until June 2007 using a stratified proportional systematic sampling method. We conducted logistic multiple regression to examine the association between factors related to provider's perception of on-site investigation and high level of perceived deterrence referring to fear of punishment after adjusting provider's service experiences and general characteristics. Results: The probability of high perceived deterrence was higher 1.7 times (CI: 1.13-2.56), 2.73 times (CI: 1.68-4.45) each among clinics exchanging the information once or more per year or once or more for 2-3 months than among clinics no exchanging the information about on-site investigation. Also, the probability of high perceived deterrence was higher 2.27 times (CI: 1.28-4.45) among clinics that knows more than 3 health care institutions having experienced an on-site investigation than among clinics knowing no case. Conclusion: A clinic knowing more punishment cases by onsite investigation and exchanging more frequently information about on-site investigation is likely to present high perceived deterrence. This result will provide important information to enlarge preventive effects of on-site investigation on fraud and abuse claims.

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