• 제목/요약/키워드: fixed insurance fee

검색결과 9건 처리시간 0.026초

OPTIMAL SURRENDER TIME FOR A VARIABLE ANNUITY WITH A FIXED INSURANCE FEE

  • Jeon, Junkee;Park, Kyunghyun
    • 대한수학회보
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    • 제58권2호
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    • pp.349-364
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    • 2021
  • This paper studies the optimal surrender policies for a variable annuity (VA) contract with a surrender option and a fixed insurance fee for guaranteed minimum maturity benefits (GMMB). In our proposed model, a policyholder pays the fixed insurance fee. Based on the integral transform techniques, we derive the analytic integral equations for the optimal surrender boundary and the value function of the VA contract that can be solved numerically by recursive integration method. We provide numerical values for the value function, the optimal surrender boundary, and the expected optimal surrender time.

한방의료서비스의 건강보험수가 산출방법과 추정 (Estimating the Reimbursing Price Level of Oriental Medical Services in the National Health Insurance)

  • 김진현
    • 대한예방한의학회지
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    • 제12권3호
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    • pp.21-34
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    • 2008
  • Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

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진료수가제도의 헌법적 한계와 정액수가제의 위헌성 -헌법재판소 2020. 4. 23. 선고 2017헌마103 결정을 중심으로- (Constitutional Limits of the Medical Fee Payment System and the Unconstitutionality of Fixed Payment System)

  • 현두륜
    • 의료법학
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    • 제21권1호
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    • pp.69-105
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    • 2020
  • 의료보장제도에서 진료수가는 의료보장체계의 근간을 이루는 매우 중요한 요소이다. 국민건강보험법은 진료수가의 결정방식에 관하여 계약제를 채택하였고, 그 계약의 내용은 상대가치점수에 대한 점수당 단가를 정하는 것이다. 그에 따라 건강보험 요양급여비용은 매년마다 물가상승이나 경제 상황의 변화에 따라 조정된다. 반면, 의료급여의 경우, 의료급여법에서는 진료수가의 결정방식에 관한 내용을 규정하지 않고, 모든 사항을 보건복지부 장관에게 위임하고 있다. 그에 따라 보건복지부 장관은 2001년부터 혈액투석 치료에 관하여 정액수가제를 채택하고 있다. 이러한 혈액투석 정액수가제에 대해서 2017년 헌법소원이 제기되었고, 헌법재판소는 2020년 헌법소원 심판 청구를 모두 기각하였다. 이 글에서는, 위 헌법소원 사건을 중심으로 진료수가제도의 의미와 내용을 살펴보고, 이에 대한 헌법적 한계로 3가지 원칙을 제시한다. 그 원칙의 첫째는 법률유보의 원칙, 둘째는 포괄위임금지의 원칙, 셋째는 비례의 원칙이다. 그러한 관점에서 검토해 보면, 혈액투석 정액수가제는 상당히 위헌적인 제도로 판단된다.

권역외상센터의 질 관리와 수가 개선 현황 (A Review of Quality Management and Improvement of Trauma Fee Schedule in Regional Trauma Center)

  • 서은원;임지혜
    • 보건행정학회지
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    • 제31권4호
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    • pp.399-408
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    • 2021
  • The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

건강보험 상대가치 개정 연구의 성과와 한계 (The Refinement Project of Health Insurance Relative Value Scales: Results and Limits)

  • 강길원;이충섭
    • 보건행정학회지
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    • 제17권3호
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    • pp.1-25
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    • 2007
  • Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

요양병원 수가제도에 대한 소고 -환자군 조정 판결을 중심으로 - (A Study on Medical Fee System of the convalescent hospital -Focused on the case of patient group adjustment -)

  • 권혜옥
    • 의료법학
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    • 제18권2호
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    • pp.195-218
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    • 2017
  • 요양병원에 대한 진료비의 증가폭이 비정상적으로 늘어나고 있어 건강보험재정에 막대한 부담을 주고 있다. 이는 요양병원 특수성이 급속한 노령화라는 사회적인 현상과 맞물리면서 나타나게 된 현상인데, 이 중 요양병원에 대하여 입원일당 정액수가제에 의하여 비용이 지급되는 점은 일부 요양병원이 환자를 돈벌이 수단으로 이용하는 유인이 되었다. 이러한 요양병원들은 일당정액수가를 지급받고도 그에 합당한 진료비용의 지출을 줄이기 위해 의도적으로 입원 환자를 타병원에서 정기적으로 진찰을 받게 하거나 주요 약제를 처방받게 하는 등 건강보험재정이 이중으로 지출되게 하였다. 이러한 재정누수를 방지하기 위하여 심사평가원은 위와 같은 환자들에 대하여 기존의 환자군을 부정하고 '신체기능저하군'으로 환자군을 조정한 다음 요양급여비용을 삭감하였다. 그렇지만 위결정은 규정상근거가 없음을 이유로 법원으로부터 취소판결을 받았다. 그러나 위 사건을 계기로 요양병원 수가제도의 문제점을 도출하고 제도를 정비하는 기회가 될 수 있다고 생각한다. 현재의 정액수가제를 수정하여 약제비 및 진료자체에 대한 행위별 청구를 일부 도입하면 요양병원의 의료적 기능을 강화할 수 있다고 생각한다. 또, 현재의 환자군 중 비슷한 군들은 통합하고 신체기능저하군은 입원이 부적절하므로 환자군에서 제외하는 것이 타당하다고 보인다. 다만, 사회적 필요에 의해 신체기능저하군을 입원대상으로 인정하게 된다 하더라도 장기요양대상과의 형평성, 건강보험재정의 건전성 등을 고려하여 건강보험대상에서는 제외되어야 한다고 생각한다.

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활동기준원가계산[ABC]을 적용한 가정 간호 원가 분석 (Cost Analysis of Home Care with Activity-Based Costing(ABC))

  • 이수정
    • 대한간호학회지
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    • 제34권6호
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    • pp.1117-1128
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    • 2004
  • Purpose: This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. Method: The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. Result: The HHC activities were classified into 70 activities. In resource, the labor cost was 245₩per minute, operating cost was 9,570₩ per visit and traffic expense was an average of 12,750₩. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741₩ and the cost ranged from 55,560₩ to 74,016₩. Conclusion: The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

한국의 호스피스완화의료정책 (Hospice & Palliative Care Policy in Korea)

  • 김창곤
    • Journal of Hospice and Palliative Care
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    • 제20권1호
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    • pp.8-17
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    • 2017
  • 종합적인 보건시스템을 지원하기 위한 완화의료정책의 개발과 강화가 세계적으로 강조되고 있다. 우리나라에서는 암정복 10개년 계획과 국가암관리종합계획의 기틀 하에 암정책의 일환으로, 호스피스완화의료정책이 시행되어왔고, 2003년 암관리법(Cancer Control Act)을 제정하여 법적 근거를 마련하였으며, 최근 호스피스 완화 의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법을 제정하여 시행할 예정이다. 호스피스완화의료정책의 대상은 최근 관련법의 제정에 따라, 말기암환자에서 암(Cancer), 후천성면역결핍증(Acquired immune deficiency syndrome, AIDS), 만성 폐쇄성 호흡기질환(Chronic Obstructive Pulmonary Disease, COPD), 만성간경화(Chronic Liver Disease/Live Cirrhosis) 등으로 확대되었고, 급여체계는 2015년에 모든 의료기관에 일당 정액수가와 행위별 수가의 복합지불방식으로 완화의료 건강보험제도가 시행되었다. 전달체계관련 건강보험제도는 입원형과 자문형, 그리고 가정형으로 구분되고, 완화의료전문기관의 지정 평가 지원제도가 운영되고 있으며, 재원체계는 건강보험기금과 국가지원금으로 조달되고 있다. 호스피스 완화의료 관련법의 시행에 앞서, 정책대상의 사회적 합의가 요구되며, 낮은 급여체계의 현실화, 민관협력을 통한 호스피스완화의료 표준설정과 전문요원양성, 질 관리 및 평가체계정립, 그리고 장기요양보험과 호스피스기금 등을 활용한 안정적인 재정체계를 마련해야 할 것이다.

가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교 (A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients.)

  • 김용순;임영신;전춘영;이정자;박지원
    • 대한간호
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    • 제29권2호
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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