Korean J Women Health Nurs.  2011 Dec;17(4):328-336. 10.4069/kjwhn.2011.17.4.328.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance

• Im H
• Kim J

• KMID: 2307967
• DOI: http://doi.org/10.4069/kjwhn.2011.17.4.328

Abstract

PURPOSE
The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system.
METHODS
The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs.
RESULTS
The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services.
CONCLUSION
More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

Keyword

Conversion factor; Nurse midwifery; Health insurance; Normal delivery nursing fee

MeSH Terms

Accounting
Bias (Epidemiology)
Fees and Charges
Financing, Government
Insurance, Health
Midwifery
National Health Programs

Figure

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  Figure 1 The sustainable growth rate (SGR) model.

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  Figure 2 Trend of total medical cost for nurse midwifery services in the national health insurance (unit; 1,000 won).

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