earticle

영어

Purpose: The objectives for this study are to produce the comprehensive management
indexes and find their application strategies for appropriate medical care in primary care
clinics under workers’ compensation insurance.
Method: Data of this study was workers' compensation insurance medical fees claim's data from July 2006 to June 2007. Data were analyzed using SAS 9.1 version by applying descriptive statistics and Pearson's correlation.
The indexes such as costliness index(CI), standard medical fee were calculated based on
the fourth revision of korean classification of diseases(KCD-4.). Results: The CI, visiting
index(VI), outliers index(OI), and medical review adjustment percentage were positively
correlated in the both inpatient and outpatient medical fees in primary care clinics under
workers’ compensation insurance. The major medical specialities were neurological surgery,
general medicine, general surgery, rehabitational medicine, and orthopedic surgery. The CIs
were slightly high in rehabitational medicine among major medical specialities. The CIs were
mostly high in diagnosis, test, anesthesia, and rehabitational assistive device fees among
major medical specialities. The CIs were slightly high in Kwangju, Daegu, Daejeon, and
Busan districts among district management centers of Korea Workers' Compensation and
Welfare Service. Conclusions: We suggest the continuous development of appropriate disease
classification system and medical care quality indicators to successfully take root the
comprehensive management for appropriate medical care under workers' compensation,