Developing a resource-based relative value scale system for traditional medicine services in the Korean national health insurance

Background: The resource-based relative value scale (RBRVS) has been increasingly used to determine payment for Western medical services. In Korea, the National Health Insurance recommended that the RBRVS be introduced into traditional Korean medicine as well as conventional medicine.

Objectives: The purpose of this study was to identify resources invested into clinical activities and to develop a new RBRVS for Korean medicine services as part of the National Health Insurance.

Methods: Based on a survey of physicians' time, physical effort & technical skill, mental effort & judgment, and stress that were used or experienced during patient treatments, the relative input values for the relevant clinical activities were estimated and rearranged in order to compare them with the current fee schedule for reimbursement in the National Health Insurance.

Results: We found that the actual resource-based relative values for Korean medicine services were statistically different from the current values, with a narrower variation in value distribution.

Conclusions: The findings suggest that the current fee schedule for Korean medicine should be revised to reflect the actual resources that physicians invest into clinical activities, in order to avoid a distortion of physicians' behavior.