No abstract available.
Relative Value Scales*

PURPOSE: Since the medical insurance system was started in Korea, there has been an imbalance in the medical charges among the procedural items of special departments. For correcting this problem, the Resource-based Relative Value Scale (RBRVS) was introduced to determine the relative values of physician services and practices. The RBRVS is the prevailing model used today to describe, quantify and reimburse physicians for their services. In this study we attempted to clarify the relative values of the practice characteristics in vascular surgery and evaluate the propriety compared with the relative value unit (RVU) of the American Medical Association (AMA). METHOD: The classification of practice characteristics in vascular surgery was compared with that of the AMA. The propriety of physicians' work was measured according to the Korean and American physicians' work. The rate more than 70, between 50 to 69, and less than 49 were used to decide over-, proper- or under-estimation, respectively. RESULT: The ratio of the number of practice characteristics in Korean and American vascular surgery was 1:3.31 (97:321). The over-, proper- or under-estimated physicians' work among the identical American practice characteristics was 8/46 (17.4%), 19/46 (41.3%) and 19/46 (41.3%) respectively. CONCLUSION: Our results demonstrated that the practice characteristics of Korean vascular surgery are not sorted by detail and a large percentage of physicians' work (41.3%) is under-estimated. Therefore, reasonable payment for physician services or practices can not be determined for Korean vascular surgery.
American Medical Association ; Fees and Charges ; Insurance ; Korea ; Relative Value Scales

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.
Human ; *Internal Medicine ; Least-Squares Analysis ; *Relative Value Scales

Missing observations are common in medical research and health survey research. Several statistical methods to handle the missing data problem have been proposed. The EM algorithm (Expectation-Maximization algorithm) is one of the ways of efficiently handling the missing data problem based on sufficient statistics. In this paper, we developed statistical models and methods for survey data with multivariate missing observations. Especially, we adopted the Em algorithm to handle the multivariate missing observations. We assume that the multivariate observations follow a multivariate normal distribution, where the mean vector and the covariance matrix are primarily of interest. We applied the proposed statistical method to analyze data from a health survey. The data set we used came from a physician survey on Resource-Based Relative Value Scale(RBRVS). In addition to the EM algorithm, we applied the complete case analysis, which used only completely observed cases, and the available case analysis, which utilizes all available information. The residual and normal probability plots were evaluated to access the assumption of normality. We found that the residual sum of squares from the EM algorithm was smaller than those of the complete-case and the available-case analyses.
Biostatistics ; Dataset ; Health Surveys* ; Models, Statistical ; Relative Value Scales

Korean resource-based relative value scale (RBRVS) was developed first in 1997 for the alternative of the traditional Korean fee-for-service system. The knowledge about the RBRVS-based fee schedule is necessary to understand the physician payment system of Korean medical insurance. Still now, it is considered that a few more issues should be modified for the most balanced and rational fee schedule in specific situation of Korea. In this article, we analyzed the current Korean medical insurance fee schedule, especially the RBRVS related to rheumatic diseases. And we introduced the guide of the medical service for rheumatic diseases in the view of approved limit under the medical insurance. In addition, the new optional medical service system, which was operated recently, was also evaluated briefly. It is suggested that the medical insurance fee schedule be modified to more acceptable and reasonable one for the best medical services. For that purpose, it is necessary for medical committee and its members to make an efforts continuously on the basis of the great insights of the current fee schedule of Korean medical insurance.
Fee Schedules ; Insurance* ; Korea ; Relative Value Scales ; Rheumatic Diseases*

OBJECTIVES: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. METHODS: We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. RESULTS: During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. CONCLUSION: More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement.
Appointments and Schedules ; Brain ; Discrimination (Psychology) ; Efficiency ; Fees, Medical ; Neurosurgeons ; Neurosurgery* ; Neurosurgical Procedures ; Relative Value Scales* ; Surgeons

The United States recently adopted an entirely new system of paying physicians for the services they provide to elderly and disabled patients. The new system is based on a fee schedule in which the relative values among different services are derived on the basis of the cost of providing such services. To control expenditure growth, a system of Volume Performance Standards (VPSs) was adopted, which explicitly links physician fee levels to the success the physician community has in controlling the total volume of services provided. This article presents and analyzes the new payment system and examines its applicability to other countries. It concludes that the methodology used to develop the fee schedule may be useful to other countries, particularly if they are unable to reach a consensus on appropriate physician fee levels, but that the VPS system needs to be refined in a number of ways before it can be successfully exported.
*Fee Schedules/legislation & jurisprudence ; Medicare Part B/*organization & administration ; Reimbursement Mechanisms ; *Relative Value Scales ; United States

BACKGROUND: The Korean Medical Association intends to determine the relative value of physician's work separately from the total relative value scale for each medical or surgical procedure. This study was designed by the Korean Society for Laboratory Medicine to determine the relative value of laboratory physician's work (LPW) in each diagnostic test. The LPW was clearly defined first and then its relative value was measured quantitatively on the basis of time and intensity of work. METHODS: LPW in the laboratory test was categorized into three parts, pre-service, intra-service, and post-service. The relative value of physician's work was measured using Rasch paired comparisons. RESULTS: Practice characteristics of LPW were clearly defined according to the pre-service, intraservice, and post-service. However, any laboratory physician's effort to improve the quality of laboratory work, which could not be measured in each test, had to be comprised in a pre-service designated separately as `comprehensive pre-service'. Rasch analysis based on the rating survey for LPW taken by a diverse group of laboratory medicine and other medical specialists revealed higher values than those assigned previously in many routine diagnostic tests (e.g., Gram stain, hemoglobin, anti-HBs, ABO cell type). The results obtained by applying Rasch regression analysis showed that the diagnostic tests that had been given a low relative value of LPW tended to be measured with more improved relative valuation. CONCLUSIONS: LPW for quality control and quality improvement was acknowledged with an improved relative valuation, even in the routine diagnostic test, as the results of Rasch analysis based on the rating survey. LPW might be further equated across the specialties, considering the practice characteristics of LPW.
Diagnostic Tests, Routine ; Matched-Pair Analysis ; Quality Control ; Quality Improvement ; Relative Value Scales ; Specialization

OBJECTIVES: To determine the level of satisfaction with the National Health Insurance Program (NHIP) among PhilHealth-accredited members of the four different medical societies (PCP, PPS, PCS and PSA) and identify areas for improvement of the NHIP.

METHODS: In 2006, UPM-NIH conducted satisfaction surveys among PhilHealth-accredited members of the Philippine College of Physicians (PCP), Philippine Pediatric Society (PPS), Philippine College of Surgeons (PCS), and Philippine Society of Anesthesiologists (PSA) during their respective national conventions. The survey questionnaire used a Leikert scale to measure level of satisfaction and was based on the key performance areas of the NHIP identified in the validation framework of the InterAgency Validation Team and key informant interviews (KIIs) of selected medical doctors. Data analysis was done using SPSS ver 14.

RESULTS AND CONCLUSION: Respondents from the PCS (surgeons) were only slightly satisfied with PhilHealth in general, while the respondents of the other three societies: (PCP - Internists, PPS - Pediatricians, and PSA - Anesthesiologists) were slightly dissatisfied with PhilHealth. Respondents of the four societies were satisfied with the accreditation process. Respondents were most dissatisfied with the length of time to be reimbursed and the amount reimbursed for their professional services. The respondents from the PCS tended to be more satisfied than the respondents of the PCP, PPS and PSA. Respondents expressed some dissatisfaction with the PhilHealth benefit package formulation. A significant percentage of respondents (about 27%) were neither satisfied nor dissatisfied with PhilHealth. These respondents could swing PhilHealth satisfaction either way and PhilHealth should make efforts to make them satisfied.

The design of the survey tool precluded a qualitative analysis of the reasons for satisfaction/dissatisfaction. But the areas of most dissatisfaction identified by the respondents have to do with reimbursement: length of time and amount. In subsequent small group discussions with different physician service providers, it was observed that there was a general low level of awareness about the principles of social health insurance, benefit design and payment mechanisms. PhilHealth should address this with regular information and service improvement campaigns to engender a more proactive role for the service providers in achieving greater financial access to needed quality health services for all Filipinos.

Respondents had recommendations to improve PhilHealth performance in the following areas: accreditation, reimbursement, SPECIAL ARTICLE benefit package formulation, administrative process, and coverage and enrollment. Many of the recommendations had to do with increasing PhilHealth efficiency, unifying the Department of Health (DOH), the Philippine Regulatory Commission (PRC) and PhilHealth standards, simplifying and decreasing requirements for the different processes and improving PHIC's information system. They also recommended revising the relative value scale (PhilHealth's system of assigning a value to a certain procedure which serves as the basis for determining the amount for reimbursement), improving coverage, formulating comprehensive benefit packages focused on the poor, and effective identification of the poor for the Sponsored Program, (PhilHealth's program for enrolling the poor).

Human ; Male ; Female ; Relative Value Scales ; Anesthesiologists ; Philippines ; Social Security ; Insurance, Health ; Pediatricians ; Surgeons ; Societies, Medical

PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.
Fees and Charges ; Glucose ; Insurance, Health ; Methods ; National Health Programs ; Nursing Care ; Nursing ; Occupations ; Relative Value Scales