[A model for the development of a reimbursement system for home health care--based on the concept of nursing cost].

Abstract

The reimbursement system for nursing services needs to be set up before beginning of the home health care system. One thing we should consider as a premise in developing a reimbursement system for home health care is that the fee-schedule of home health care should be based on the cost of unit service, since the medical reimbursement system in Korea basically depends upon the concept of 'fees for service'. A model for the development of the fee schedule was designed to make some contribution to the reimbursement system for home health care, which should be prepared before the enhancement of a new system. The model is composed of three processes as follows: cost finding of the home health care department, cost computation by service of health care, development of the fee-schedule. 1. Cost finding of the home health care department The home health care department can be defined as a major cost center producing revenues. The costs of home health care department consist of the individual costs produced in more than two departments at the same time and, therefore, should be distributed to the home health care department by certain distribution rate, and the costs which are distributed from the auxiliary departments. 2. Cost computation by service of health care The services where the costs are finally aggregated to should be defined. The direct costs which can be found by service are rendered directly to the corresponding services and the indirect costs which cannot be recognized by service should be distributed to by the distribution rate. Lastly, the costs which were passed over from the auxiliary are added to. 3. Development of the fee-schedule The costs per unit service should be transformed into the relative values. The price of the unit value is produced by dividing required revenues needed to perform the home health care activities with what aggregated relative values. The formula to produce the fees of home health care is as follows: Fi = RVi x P P = NR/sigma RVi x ni Fi: the fee of service i RVi: relative values of service i P: unit price of RV i NR: required revenues Ni: expected number of cases of service i in a year.