치과의원 건강보험 진료비 청구실태에 대한 연구 - 부산광역시 소재 일부 치과의원을 대상으로
A Survey on Health Insurance Claim Affairs among Dental Clinics
홍선아,
소속 상세정보
홍선아 ( Hong Sun-A ) - 대한치과경영교육연구원
KMID : 1004420100010010017
Abstract
Objectives : This study aimed at providing basic data that can be used in establishing an improvement plan for health insurance-related tasks in dental clinics by surveying the current situation of the calculation, receipt, and claim affairs of health insurance.
Methods : The data were collected by a self-administered questionnaire from 311 practitioners on health insurance tasks in dental clinics located in Busan Metropolitan City.
Results : Firstly, 74.9% of the practitioners did not receive insurance training within the recent six months, and 62.4% of them were not aware of the revised calculation standard that was notified to be in effect as of 2010. Secondly, 34.7% of them experienced unpaid notice but did not proceed complementary claims, and 60.5% of them experienced claims reduction by insurance reviewer but did not follow any objection process. The reasons were either they did not know how to follow the process, or they felt that the task was too complicated, or the amount of claims in question was too small and consequently, they gave up following the process. Thirdly, 51.8% of them scored 10 or less out of 20 in the health insurance claim knowledge test, and only 10.3% of them scored 16 or over. Fourthly, the affecting factors on the level of the knowledge were the number of employees, staff’s history of health insurance training during previous college education, the training experience in the recent six months, and staff’s subjective level of knowledge.
Conclusions : Most of the practitioners had little understanding of health insurance claims. In order to improve the level of the knowledge of health insurance claims in dental clinics, it is advised that the staff in charge of health insurance claims make effect in improving their overall awareness of health insurance, and that regular and continuous training programs be offered to them.
키워드
건강보험교육; 지식수준; 진료비 청구; 치과 건강보험
Dental insurance; Health insurance education; Knowledge level; Medical cost claim
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