구강병 예방진료 일부항목의 건강보험급여를 위한 재정추계 연구
The research on an actuarial budget of insurance payment for some items of preventive dental service
이영수, 이영현, 이규식,
소속 상세정보
이영수 ( ) - 연세대학교 보건과학대학원 보건관리전공
이영현 ( ) - 강릉대학교 치과대학 예방치학교실
이규식 ( ) - 연세대학교 보건과학대학원 보건관리전공
KMID : 0355420030270040539
Abstract
Objectives: This study aims (1) to determine the actuarial budget of national insurance payment for some items of preventive dental service and (2) to obtain basic data to develop dental policy which is for including preventive dental service within insurance payment.
Methods: Pit and Fissure Sealing (PFS), Self-Plaque Control Instruction (S-PCI), and Fluoride Topical Application (FTA) were selected for some items of preventive dental service. The actuarial budget of insurance payment was calculated through multiplying followings;
1) Applicable population or number of teeth (based on population data and Korean National Oral Health Survey 2000)
2) The usual and customary fee of 2001 from three dental colleges which have preventive dental clinic or RBRVS (Resource based relative value scale) fee which was multiplied the RBRVS developed through the research of Yonsei University and conversion factor Korean Ministry of Health and Welfare had announced at 2001 as 55.4 won
3) 70% of insurer share rate
4) The utilization rate of the items of preventive dental service presumed to be at least 5% and at the most 36%
Results: Actuarial budgets of 1) PFS are 18.8 billion (usual and customary fee) and 5.7 billion (RBRVS fee) for 5% utili7.ation rate and 135.1 billion (usual and customary fee) and 41 billion (RBRVS fee) for 36% utilization rate when limited to first molar and second molar which are firstly facing teeth of 6-14 age group; 2) ETA are 2.5 billion (usual and customary fee) and 1.5 billion (RBRVS fee) for 5% utilization rate and 18.3 billion (usual and customary fee) and 10.6 billion (RBRVS´ fee) for 36% utilization rate when
applied only to 6-14 age group annually once; 3) S-PCI are 9.1 billion (usual and customary fee) and 5.5 billion (RBRVS fee) for 5% utilization rate and 65.7 billion (usual and customary fee) and 39.8 billion (RBRVS fee) for 36% utilization rate when limited over 12 age group who could have periodontal pocket.
Conclusions: The actuarial budgets of PFS, FTA, and S-PCI if they were included within insurance payment system are minimum 13 billion and maximum 219´ billion. It is presumed, however, that over 1,000 billion for dental treatment and the pain and time consuming from oral disease could be decreased when dental caries and periodontal disease were prevented effectively. As a conclusion, preventive dental service should be included to the insurance payment system to decrease budget.
키워드
건강보험급여;구강병 예방진료;재정추계;actuarial budget;insurance payment;preventive dental service
원문 및 링크아웃 정보
등재저널 정보