The study on the development of relative value in medical treatment of the oral and maxillofacial surgery

Song, Gin Ah; Baek, Kyung Won; Hwang, Jong Min; Yu, Soon Yong; Choi, Jin Young

Abstract

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.