Problems of Medical Invoice System in Operating Room Analysis of Loss of Incomes by Mistakes or Other Factors.

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  • 保険請求における手術・麻酔関連請求漏れの実態とその対策　　茨城県立中央病院の場合

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Abstract

We analysed the loss of operation fee obtained from 2, 900 consecutive surgical patients of Ibaraki Prefectural Central Hospital in 1998 to 1999, by checking the mistakes and others in medical invoice system following the rules of national and social health insurance of Japan.<br>As the result, the total loss achieved about 21 millions yen in 369 cases. 82% of the total loss was from mistakes in evaluation or identification of surgery following the rules, 13% was from mistakes related to anesthesia, and the rest was related to materials and drugs. Regarding the cause, about 1/3 of total was simple human error, and the other 1/3 was error inchecking, but it includes some problems in many factors in medical invoice system, and the rest originated from complexity of the rules. <br>Little knowledge of the rules of insurance and medicine in medical staffs and clerks, respectively, may occupy main part of this problem. But the system of national and social health insurance of Japan may also have some problems regarding econometric evaluation of operation.

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