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Dentists¢¥ Opinions in The Dental Field of Present Health Insurance Claim and Review
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KMID : 0355220050300020215
Abstract
ÀÌ Á¶»ç³í¹®Àº °Ç°º¸Çè Áß ±¸°¿ä¾ç±Þ¿©ÀÇ Ã»±¸ ¹× ½É»çµî°ú °ü·ÃÇÏ¿© Àϼ± °³¿øÄ¡ÀǵéÀÇ °ßÇظ¦ Á¶»çÇÏ°í, º¸Çè°ü·ÃÁ¤Ã¥¼ö¸³¿¡ °³¿øÄ¡ÀǵéÀÇ ÀÇ°ßÀ» Àû±Ø ¹Ý¿µÄÚÀÚ Çϴµ¥ ±× ÀÇÀǸ¦ µÎ°í ÀÖ´Ù. º» Á¶»ç´Â 2004³â 2¿ù°æ¿¡ ºÎ»ê±¤¿ª½Ã¡¤°æ³²ÀÏ´ë¿¡ °³¿øÇÏ°í ÀÖ´Â 1,465¸íÀÇ °³¿øÄ¡ÀǸ¦ ´ë»óÀ¸·Î ¼³¹®Á¶»ç¸¦ ½Ç½ÃÇÏ¿© À̵é Áß¿¡¼ 406¸íÀ¸·ÎºÎÅÍ ´äº¯À» ¾ò¾ú°í, ±× ³»¿ëÀº ¾Æ·¡¿Í °°ÀÌ ¿ä¾àÇÒ ¼ö ÀÖ´Ù.
1. û±¸¾÷¹«¿Í °ü·ÃµÈ»çÇ× : º¸Çèû±¸ÀÇ ´ã´çÀº ´ëü·Î Ä¡°úÀ§»ý»ç(°£È£Á¶¹«»ç)¿Í Ä¡°úÀÇ»çÀÇ Á÷Á¢Ã»±¸¹æ½ÄÀÌ ¸¹¾Ò´Ù.
´ëÇàû±¸´Â ±× ºñÁßÀÌ Àüü¿¡¼ 20%¹Ì¸¸À» Â÷ÁöÇß´Ù.
2. º¸Çè°ÁÂÀÇ Âü¿©µµ : º¸Çè°Á¿¡ ´ëÇÑ °ü½ÉÀº ºñ±³Àû ÀúÁ¶ÇÑ °ÍÀ¸·Î ³ªÅ¸³µ´Ù.
3. ÀÌÀǽÅûÀ¯¹« : º¸Çèû±¸¿¡ °ü·ÃÇÑ ÀÌÀǽÅû À¯¹«´Â ¾ùºñ½ÁÇÏ°Ô ³ªÅ¸³µ´Ù.
4. °Ç°º¸Çè ½É»ç±ÔÁ¤¿¡ °üÇÑ °³¿øÄ¡ÀǵéÀÇ °ßÇØ : ÇöÀçÀÇ Áø·áºñ ½É»ç±ÔÁ¤ Áöħ¿¡ ´ëÇÑ °³¿øÄ¡ÀǵéÀÇ »ý°¢À» ¹¯´Â Áú¹®¿¡ ´ëÇÑ ÀÀ´äÀ¸·Î´Â ¡°½É»ç±âÁØÀÌ ³ÇØÇÏ°í ºÎ´çÇÑ »è°¨ÀÌ ¸¹Àº °Í °°´Ù¡±´Â ÀÀ´äÀÌ ¾ÐµµÀûÀ¸·Î ¸¹¾Ò´Ù.
5. °Ç°º¸Çè½É»çÆò°¡¿ø°ú °ü·ÃÇÑ »çÇ× : ¾à 70%ÀÇ °³¿øÄ¡ÀǵéÀº °Ç°º¸Çè½É»çÆò°¡¿øÀ¸·ÎºÎÅÍ ÀÚÀ²Áöµµ¶ó´Â ¸íºÐÇÏ¿¡ ÀÌ·ç¾îÁö´Â ´ëȹæ½Ä¿¡ ºÒ¸¸À» Ç¥½ÃÇß´Ù.
6. Áø·áºñ ¿µ¼öÁõ ¹ß±Þ¿¡ ´ëÇÑ °³¿øÄ¡ÀǵéÀÇ ÀÔÀå : ¾à 70%ÀÇ °³¿øÄ¡ÀǵéÀº Áø·áºñ ¿µ¼öÁõ ¹ß±Þ¿¡ ¿©·Á¿òÀ» °Þ°í ÀÖ¾ú´Ù.
7. °Ç°º¸Çè ºñ±Þ¿© Áø·áºÐ¾ßÀÇ ±Þ¿©Àû¿ë¿¡ °üÇÑ »çÇ× : ´ë´Ù¼öÀÇ °³¿øÄ¡ÀǵéÀº Àü¾Ç ½ºÄ̸µÃ³Ä¡¿Í Ä¡¸é¿±¸Àü»öóġ ¹× ºÒ¼ÒµµÆ÷¿Í °°Àº ¿¹¹æÄ¡·á¿¡ ´ëÇؼ´Â ±Þ¿©Àû¿ëÀ» Èñ¸ÁÇÏ¿´´Ù.
³ëÀÎƲ´Ï,±Í±Ý¼ÓÀ» Á¦¿ÜÇÑ º¸Ã¶Ä¡·á, ±¤ÁßÇÕ·¹ÁøÄ¡·á µî¿¡ °üÇÏ¿©´Â ºñ±Þ¿©Àû¿ëÀ» Èñ¸ÁÇÏ¿´´Ù.
The study was intended to investigate how dentists in private dental clinic thought on the present claim and review of dental insurance to reflect it in future establishing dental insurance policies. 1,465 dentists who were running own dental clinic in Pusan Metropolitan City and the south part of Kyungsang province were surveyed in February, 2004. A total of 406 copies of finished questionnaire were finally retrieved and analyzed. The findings are as follows.
1. About insurance claim affairs : Most of the subject of insurance claim was by dentist himself or dental hygienist(nurse). Agency claiming was carried under 20% of total insurance claim.
2. The degree of attendance on insurance lecture : The degree of attendance on insurance lecture was relatively low.
3. Filing a protest against insurance claim : Filing a protest against insurance claim was reavealed about half-and-half for ¡°have been¡± or ¡°have not been¡±.
4. Private clinic dentist,s opinion about the regulations affecting review of dental insurance : Private clinic dentist,s opinion about current guide for insurance review of dental fee was¡°the guidance is difficult and unfair cutback of claim fee may be carried¡±.
5. The affairs about health insurance review agency : About 70% of private clinic dentists have dissatisfaction on health insurance review agency.
6. Standpoint of private clinic dentists about issuance of receipt for dental fee : About 70% of private clinic dentist have an difficulty in issuance of receipt for dental fee.
7. The affairs about change insurance noncoverage treatment to insurance coverage treatment : Most of private clinic dentists hoped that insurance coverage about full mouth scaling, pit and fissure sealant, fluoride application.
But they do not hoped that insurance coverage about geriatric denture, prothodontic treatment except precious metal, photopolymerization resin treatment.
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