Journal List > J Korean Acad Nurs > v.39(4) > 1002559

TOOLS
Kim and Jung: 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
Original Article
Journal of Korean Academy of Nursing

Journal of Korean Academy of Nursing 2009; 39(4): 574-583.

Published online: 31 August 2009

DOI: https://doi.org/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

Jinhyun Kim1, Yoomi Jung2

1Associate Professor, College of Nursing, Seoul National University, Seoul, Korea.

2Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea.

Address reprint requests to: Jung, Yoomi. College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: 82-2-740-8459, Fax: 82-2-766-1852, wow30@snu.ac.kr

Received 16 March 2009       Accepted 24 July 2009

Copyright © 2009 Korean Society of Nursing Science

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.

Keywords: Conversion factor, Nurse fee, Nurse-midwife, Reimbursement

Figures and Tables

Table 1
Relative Value Scale and Fee Schedule for Nurse-midwife's Delivery Service*
jkan-39-574-i001

*This table was produced by transforming and calculating the data from Health Insurance Review & Assessment Service (2008); †Midwife fee=RVS×CF. RVS=relative value scale; KRW=Korean won.

Table 2
Estimates of Optimal Fees for Nurse-midwife's Clinic by SGR model
jkan-39-574-i002

*Data from national health insurance statistical yearbook (National Health Insurance Corporation, 2008); †Data from macroeconomic indicator (KNSO, 2008); ‡Optimal fee increase rate=(1+PAF)×(1+MEI)-1; §CF (conversion factor)=80.7×(1+PAF)×(1+MEI); ∥As of 2009, the actual value of conversion factor for nurse-midwife' clinic is 88.2 in the national health insurance.

SGR=sustainable growth rate; GDP=gross domestic product.

Table 3
Actual vs Optimal Conversion Factor for Nurse-midwife's Clinic by SGR model
jkan-39-574-i003

SGR=sustainable growth rate; CF=conversion factor.

Table 4
Optimal Conversion Factor for Nurse-midwife's Clinic by Cost Analysis
jkan-39-574-i004

*R1 indicates revenue from health insurance and R2 from non-insurance services; †C1 indicates cost from health insurance and C2 from non-insurance services; ‡The actual values of conversion factor for nurse-midwife' service in the national health insurance are 80.7 and 88.2 in 2008 and 2009, respectively.

CF=conversion factor.

References

1. Ahn TS, Lee PS, Oh DI, Lee YT. Cost analysis of clinics and hospitals. 2001. Seoul: Seoul National University, Business Research Center.
2. Ahn TS, Park EC, Kwon HG, Ahn IH, Choi BH. Cost analysis of health care institutions from financial statements. 2002. Seoul: Seoul National University, Business Research Center.
3. Cho H. A study on the method to estimate the cost of hospice care. Journal of Korean Academy of Nursing. 1994. 24:216–225.
4. Cho SY, Park JH. Development of a nursing fee schedule model. Journal of Korean Academy of Nursing. 1993. 23:68–89.
5. Choi BH. Medical fee contract system: Review and prospects. Korean Journal of Insurance Medicine. 2003. 3:68–78.
6. Choi BH, Hur SI, Kang GW, Eun SJ, Shin JE, Moon SH, et al. Payment policy reform in the national health insurance. 2007. Seoul: Korea Institute for Health and Social Affairs.
7. Choi BH, Shin YJ, Shin HW, Oh DO. Modelling an sustainable growth rate-based conversion factor for resource-based relative value scale. 2003. Seoul: Korea Institute for Health and Social Affairs.
8. Health Insurance Review & Assessment Service. Health insurance claims data. 2008. Seoul: Author.
9. Jeon CS. Review and prospects for medical fee contract system in Korea. Korean Journal of Insurance Medicine. 2008. 3:53–60.
10. Jeong DC. How to optimize physician fee: Conversion factor for clinics in the national health insurance. Paper presented at the meeting of the Korean Health Economics Society. 2007. 11. Seoul:
11. Kim JH. An empirical analysis of conversion factor for relative value scale in the National Health Insurance. Journal of Health Economics and Policy. 2005. 11(2):33–64.
12. Kim JH. Methods and applications in calculating conversion factor. Paper presented at the meeting of the Korean Health Economics Society. 2007. 11. Seoul:
13. Kim JH, Choi BH. Classification of conversion factors for resource-based relative value scale in the National HealthInsurance. Journal of Preventive Oriental Medicine. 2006. 10(2):147–158.
14. Kim JH, Jeong HY, Kim JP, Song JH, Ryu GC, Yoo WG. Estimation of conversion factors for the year 2005 in the national health insurance. 2004. Gimhae: Inje University, Health Science Research Center.
15. Kim JH, Lee JK, Jeong HJ. An sustainable growth rate-based conversion factor for resource-based relative value scale in the national health insurance. 2004. Seoul: National Health Insurance Corporation.
16. Kim JH, Ryu GC, Yoo WG, Jeong EH, Jeong HJ, Lee TJ. Estimation of conversion factors for the year 2009 in the national health insurance. 2008. Seoul: Seoul National University.
17. Kim JH, Ryu GC, Yoo WG, Jeong EH, Yi JO. Estimation of conversion factors for the year 2007 in the national health insurance. 2006. Seoul: Seoul National University.
18. Kim JH, Yi HY, Jeong HJ. A national survey of out-of-pocket payment in the national health insurance. 2008. Seoul: National Health Insurance Corporation.
19. National Health Insurance Corporation. 2007 National health insurance statistical yearbook. 2008. Seoul: National Health Insurance Corporation.
20. National Macroeconomic Data. Korea National Statistical Office. 2008. Retrieved September 30, 2008. Available from: URL:http://www.kosis.kr.
21. Oh DI. Methods of calculating medical cost and recommendations: Conversion factor for hospitals in 2008. Paper presented at the meeting of the Korean Health Economics Society. 2007. 11. Seoul:
22. Park JH, Song MS. Determination of nursing costs for hospitalized patients based on the patient classification system. Journal of Korean Academy of Nursing. 1990. 20:16–37.
23. Park SG. Problems and alternative policy for medical fee contract system in Korea. Korean Journal of Insurance Medicine. 2008. 3:61–67.
24. Ryu H, Jung K, Lim J. Test on the cost and development on the payment system for home health care nursing. Journal of Korean Academy of Nursing. 2006. 36:503–513.
25. Yonsei University. A study of resource-based relative value scale. 1997. Seoul: Yonsei University, Research Center for Health Policy and Management.
TOOLS
Similar articles