Analysis of Medical Charges in Industrial Accident Compensation Insurance System

Moon, Young Hahn; Cha, Bong Suk; Roh, Jaehoon; Lee, Myung Keun; Lee, Kyung Jong; Chang, Se Jin

Abstract

A recent increase in hospital cost in Industrial Accident Compensation System has caused an issue. Especially the many problems in assessing and paying hospital cost have made necessary improvement measures on this. For this purpose the study analyzed 179,442 medical bills for industrial accident patients during 1986~1988. And various annual statistic data, references and documentations are also reviewed. The results of this study were as follows: 1. The average days for medical treatment per injury decreased depending upon hospital grade in the order of clinic, hospital, and general hospital, and the average hospital charges per injury decreased in the order of general hospital, hospital and clinic. 2. The inpatients' leading injury was traumatic amputation of fingers, and the open wound of fingers came to leading injury among the outpatients. The proportions of 10 leading injuries among inpatients and outpatients were 42.7% and 49.2% respectively. 3. As a consequence of the analysis of average medical charges, fractures of neck of femur in inpatients, and intervertebral disc disorders in outpatients were obtained as the most prevalent injuries. The coal workers' pneumoconiosis and injury to nerve roots and spinal plexus were most prominent injuries with repect to the days for medical treatment. 4. According to annual days for medical treatment, fracture of tibia and fibula was the most prevalent in inpatients, and sprains and strains of back was the most prevalent in outpatient. Traumatic amputation of fingers and other 10 leading injuries has a 42.6% share of total inpatients' hospital charges, and fracture of phalanges of hand and other 10 leading injuries possessed 53.4% of total outpatients' hospital charges. 5. Multiple regression analysis revealed that length of hospital stay, number of revealed that length of hospital stay, number of radiologic examinations, duration of operation, age, and others were the major determinants of total hospital charges. A comparision with medical insurance and car insurance for hospital charges and days for treatment showed 2-4 times higher than medical insurance, but showed 0.4~1.0 times lower than medical insurance and car insurance for daily treatment charges.