Health Policy Manag.  2018 Jun;28(2):138-144. 10.4332/KJHPA.2018.28.2.138.

The Impact of Diagnostic Imaging Fee Changes to Medical Provider Behavior: Focused on the Number of Exams of Computed Tomograph

• Cho SJ
• Kim D
• Yun EJ

• KMID: 2416651
• DOI: http://doi.org/10.4332/KJHPA.2018.28.2.138

Abstract

BACKGROUND
Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes.
METHODS
The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied.
RESULTS
The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals.
CONCLUSION
Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

Keyword

Diagnostic imaging; Health insurance; Supplier-induced demand

MeSH Terms

Diagnostic Imaging*
Fees and Charges*
Insurance, Health
National Health Programs