earticle

영어

This study investigates the differences in medical practices and medical cost according to auto insurance companies based on 8,589,602 cases that were treated by auto insurance corporation for the year of 2015, from the beginning of January to the end of December. The results of this study can be summarized following. First, in terms of the general characteristic in medical treatment, especially the age, the highest figure in both non-life insurance and mutual aid cooperative was shown in the age of 50 to 59 at 22.8 per cent(p<0.001). Second, in terms of a medical cost per a hospital care, classified by clinic, the costs in the department of internal medicine were much higher than those in the surgical department, and the thoracic surgery among parts of the surgical department showed the highest figures in both non-life insurance and mutual aid cooperative. According to the above summarized results of this study, it can be concluded that Health Insurance Review and Assessment Service has to address the problem on the increase of unnecessary costs and the occurrence of social expenses caused by the delay of patients' rehabilitation and return to their daily lives, by carrying out the evaluation for the appropriateness to organizations that ask for payments of auto insurance.

한국어

이 연구는 2015년 1월부터 12월까지 1년간의 자동차보험으로 진료 받은 치과와 한방을 제외한 의과 8,589,602건에 대해 자동차보험회사별로 진료특성과 진료비 차이를 분석한 것으로 그 결과는 다음과 같다. 첫째, 일반적 특성 중, 연령에서는 손해보험과 공제조합 모두 50-59세가 22.8%로 가장 높은 것으로 나타났다(p<0.001). 둘째, 진료과별 입원 건당진료비는 손해보험과 공제조합 모두 내과계가 외과계보다 높은 것으로 나타났으며, 외과계 세부과목별로는 손해보험회사와 공제조합 모두 흉부외과가 가장 높게 나타났다. 이상의 연구결과를 볼 때, 심사평가 원에서는 자동차보험 청구요양기관에 대한 적정성평가를 실시하여 불필요한 진료비를 증가시키는 문제와 환자의 재활 및 일상생활의 복귀가 지연되어 발생하는 사회적 비용 문제를 해결하여야 할 것으로 사료된다.