Objective:With the aging of society, the importance of medical and dental cooperation has been recognized, and health insurance includes items such as comprehensive medical management surcharge(CMMS)and medical management fee for dental treatment(MFDT). In addition, a medical information cooperation sharing fee(MICSF)and medical information provision fee 1(MIPF1)have been set for information-sharing and provision. Therefore, this study aimed to clarify the insurance calculation status of these items.
Method:From the statistics on social medical treatment procedures in June 2023, the number of CMMS, MFDT, MICSF, and MIPF1 were extracted for each clinic and hospital, divided into general medical care and advanced care, and the number of cases per medical institution and the calculation rate per patient were calculated.
Results:Per medical institution, the number of CMMS and MFDT cases in hospitals was about twice that of clinics, but the number of MIPF1 and MICSF cases was more than 20 times. The proportion of advanced care was about half in both cases, but only MIPF1 was around 20%, and advanced care was low.
The billing rate for CMMS was under 1% and that for MFDT was under 5%, both of which were more common in advanced care, with no significant difference between clinics and hospitals. For MIPF1, there was no significant difference between general medical care and advanced care at clinics, with rates under 1%, but it was higher at hospitals, and was more common in general medical care. For MICSF, rates were more common in advanced care and hospitals, but all were very low.
Discussion and conclusions:Billing for CMMS, MFDT, MIPF1, and MICSF was low, revealing that medical-dental cooperation is insufficient. The fundamental reason for this is that billing for MICSF, which is a referral to the medical department, is particularly low, suggesting the need for countermeasures.
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