Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance.
10.4040/jkan.2009.39.4.574
- Author:
Jinhyun KIM
1
;
Yoomi JUNG
Author Information
1. College of Nursing, Seoul National University, Seoul, Korea. wow30@snu.ac.kr
- Publication Type:Original Article ; English Abstract
- Keywords:
Conversion factor;
Nurse fee;
Nurse-midwife;
Reimbursement
- MeSH:
Costs and Cost Analysis;
Female;
Humans;
Insurance, Health, Reimbursement/*economics;
Korea;
National Health Programs/*economics;
Nurse Midwives/*economics;
Pregnancy;
*Relative Value Scales
- From:Journal of Korean Academy of Nursing
2009;39(4):574-583
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. METHODS: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. RESULTS: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. CONCLUSION: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.
