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Im and Kim: Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance
Original Article
Korean Journal of Women Health Nursing

Korean Journal of Women Health Nursing 2011; 17(4): 328-336.

Published online: 28 December 2011

DOI: https://doi.org/10.4069/kjwhn.2011.17.4.328

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

Hyomin Im1, Jinhyun Kim2

1RN, Seoul National University Hospital, Korea.

2Associated Professor, College of Nursing, Seoul National University, Korea.

Address reprint requests to: Kim, Jinhyun, College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: 82-2-740-8818, jinhyun@snu.ac.kr

Received 9 October 2011       Accepted 5 December 2011

Copyright © 2011 Korean Academy of Women's Health Nursing

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.

Keywords: Conversion factor, Nurse midwifery, Health insurance, Normal delivery nursing fee

Figures and Tables

Figure 1
The sustainable growth rate (SGR) model.
kjwhn-17-328-g001
Figure 2
Trend of total medical cost for nurse midwifery services in the national health insurance (unit; 1,000 won).
kjwhn-17-328-g002
Table 1
Trend of Medical Institutions and Nurse Midwifery (unit: institution)
kjwhn-17-328-i001

Note. Dental and oriental medicine institutions are not included; Source: Health insurance review and assessment service (2010).

Table 2
Medical Costs of Normal Delivery Services (Unit: KRW)
kjwhn-17-328-i002

Note. Data: Health insurance review & assessment service (2010).

Table 3
Fee Adjustment Rate and Conversion Factor for Nurse Midwifery Services in the National Health Insurance for 2011
kjwhn-17-328-i003

†Non-medical insurance benefit has not been considered. The fee would increase by 1.4% if non-medical insurance benefit is included.

Table 4
Effects of Pre-delivery Subsidy Program on Demand for Nurse Midwifery Services
kjwhn-17-328-i004

Note. The distribution range of price elasticities is from Folland, Goodman, & Stano (2005).

Notes

This article is based on a part of the first author's master's thesis from Seoul National University.

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