Comparison of Asan Medical Center Criteria and National Health Insurance Criteria Among Emergent Patients

Moon,  Yi Sang; Lim,  Kyoung Soo; Seo,  Dong Woo; Kim,  Won; Jo,  Min Woo; Lee,  Sang Il

J Korean Soc Emerg Med > Volume 15(2); 2004 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2004;15(2): 64-74.

Comparison of Asan Medical Center Criteria and National Health Insurance Criteria Among Emergent Patients

Yi Sang Moon, Kyoung Soo Lim, Dong Woo Seo, Won Kim, Min Woo Jo, Sang Il Lee

¹Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. kslim@amc.seoul.kr
²Department of Preventive Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT

PURPOSE:
To solve the problems of overcrowding in the emergency department (ED), the Korean government adopted the new emergency fee schedule into National Health Institute (NHI) as of April 2000. The purpose of this system was to determine non-emergent patients from visiting the ED. However, there have been no studies regarding the decision criteria for what constitute an 'emergency'. For that reason, we compared the concordance between the criteria used at the Asan Medical Center since 1998 to designate an emergency with those used by the government to improve the system.
METHODS:
We performed a retrospective study by collecting the data from 107,097 patients who visited Asan Medical Center from January 1st, 2001, to December 21st, 2002. The criteria on emergency in NHI consist of 36 items, while the criteria at Asan Medical Center are decided by emergency physician and nurse when the patient arrived at the ED. Based on laboratory and radiologic data, a secondary decision is made when the patient is moved from triage to the adult resuscitation room or transferred to an other medical center or discharged.
RESULTS:
The number of patients who were classified as emergent by both criteria was 22,452 (21%), the number of patients who were classified as non-emergent by both criteria was 39,657 (37%), and the number of patients who were classified in the same way by both criteria was 62,109 (58%). The number of patients for whom the two sets of criteria gave different classification was 44,988 (42%). The Kappa value was 0.138 (p < 0.005). CONCILUSION: There was high discordance between the criteria used by Asan Medical Center and NHI. Further studies and improvements are required.

Key words: Emergency, Fee, National Health Insurance