A Change in Referral from Department of Family Medicine to Other Departments of One Tertiary Hospital after Partial Changes in Health Care System

Yang, Yong Min; Choi, Hyun Rim; Kim, Byung Sung; Won, Chang Won; Kim, Won Wha

Abstract

BACKGROUND: Since March 1, 1989, a new health care system has been introduced. But the departments of ENT, ophthalmology, dermatology and PMR (rehabilitation medicine) in tertiary health care hospitals were exempted from the new system and were allowed to see patients directly. Thereafter, the Ministry of Health revised the National Health Insurance regulation, and required the above departments to see patients only with referral. This study was done to analyze whether the revision has contributed to providing adequate specialized medical services and to know what role family physicians can assume under revision by analyzing the referred patients.
METHODS
From November 1998 to June 2000 and from July 2000 to February 2002, both 20 months, we reviewed the charts of 331 patients who were referred from family medicine department of KHMC (Kyung Hee Medical Center) to the above four departments and analysis has done.
RESULTS
During both periods, the number of cases increased from 94 to 237, and the patients group had no significant difference in age and sex. Reviewing the number of referred cases, before revision, cases were concentrated to the department of ENT and to PMR. After revision, cases were evenly distributed in three departments. except for PMR. Reviewing referral contents, the three departments except for dermatology showed no significant difference.
CONCLUSION
The sum of cases increased by 2.5 times, but the three departments except for dermatology showed no significant difference in referral and diagnosis content. In dermatology, the majority of the patients wanted a referral with the objective of obtaining a referral paper. Therefore, we can consider that the revision didnot contribute to specialized medical services. But after revision, referral cases to ophthalmology and dermatology increased by 4 and 6 times. We recommend that family physicians know and experience more about these.