J Korean Acad Nurs.  2009 Aug;39(4):574-583. 10.4040/jkan.2009.39.4.574.

Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance

• Kim J
• Jung Y

• KMID: 820234
• DOI: http://doi.org/10.4040/jkan.2009.39.4.574

Abstract

PURPOSE: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services.
METHODS
A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis.
RESULTS
The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services.
CONCLUSION
Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Keyword

Conversion factor; Nurse fee; Nurse-midwife; Reimbursement

MeSH Terms

Costs and Cost Analysis
Female
Humans
Insurance, Health, Reimbursement/*economics
Korea
National Health Programs/*economics
Nurse Midwives/*economics
Pregnancy
*Relative Value Scales

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