Open Access, Peer-reviewed
eISSN 2093-758X
    J Korean Acad Nurs. 2009 Aug;39(4):574-583. Korean.
    Published online Aug 31, 2009.
    https://doi.org/10.4040/jkan.2009.39.4.574
    Copyright © 2009 Korean Society of Nursing Science
    Original Article

    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 Kim,1 and 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, Email: wow30@snu.ac.kr
    Received March 16, 2009; Accepted July 24, 2009.

    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

    Tables

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

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

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

    Table 4
    Optimal Conversion Factor for Nurse-midwife's Clinic by Cost Analysis

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    MeSH Terms
    Relative Value Scales*
    Costs and Cost Analysis
    Female
    Humans
    Insurance, Health, Reimbursement/economics*
    Korea
    National Health Programs/economics*
    Nurse Midwives/economics*
    Pregnancy
    Metrics
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