Medical Expenses for Trauma According to the Type of Medical Insurance

Park,  Heeseung; Jung,  Yooun Joong; Kim,  Young Hwan; Kim,  Tae Hyun; Km,  Min Ae; Kyoung,  Kyu Hyouck; Kim,  Jung Jae; Hong,  Suk Kyung

Search: J Trauma Inj Search

CLOSE

Original Article

Journal of Trauma and Injury 2012;25(4):178-187.

Medical Expenses for Trauma According to the Type of Medical Insurance

Heeseung Park, Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Km, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong

¹Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. skhong94@amc.seoul.kr
²Department of Nursing Team, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
³Department of Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea.
⁴Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

외상환자의 보험체계에 따른 진료비 분석

박희성∙정윤중1∙김영환∙김태현∙금민애∙경규혁2∙김정재3∙홍석경

울산대학교 의과대학 서울아산병원 외과학교실 외상 및 중환자 외과,
1서울아산병원 중환자 간호팀 외상전문간호사, 2인제대학교 의과대학 해운대백병원 외과학교실 외상외과,
3울산대학교 의과대학 서울아산병원 정형외과

Received: 4 October 2012 • Revised: 5 October 2012 • Accepted: 25 October 2012

Abstract

PURPOSE
In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system.
METHODS
From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged.
RESULTS
Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge.
CONCLUSION
We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

Key Words: Trauma; Intensive care unit; Health insurance

TOOLS