□ ‘합리적 의료이용 모니터링대상’(산정특례대상자 구축 데이터)
이 데이터는 국민건강보험공단이 산정특례 적용 대상자의 의료이용 행태를 모니터링하기 위해 구축한 자료로, 특정 고비용·중증질환에 대한 합리적 진료이용을 유도하고 건강보험 재정 건전성을 확보하기 위한 목적에서 활용됩니다.

o 테이블명: TBHCFK83
o 대상: 해당년도 국민 건강보험 가입자
o 내용: 해당년도 해당 월 산정특례 대상자 발췌한 뒤 대상자 제외 및 외래이용횟수, 진료비 등 변화 모니터링
- 산정특례적용구분코드: 1:암환자, 2:희귀난치, 3:중증화상, 4:중증치매, 5:희귀/극희귀, 6:중증난치, 7:상세불명희귀, 8:기타염색체이상질환 □ 'Rational Medical Utilization Monitoring Target' (Data for Special Calculation Target) This data is data built by the National Health Insurance Corporation to monitor the medical utilization behavior of the special calculation target, and is used for the purpose of inducing rational treatment utilization for specific high-cost/serious diseases and securing the financial soundness of health insurance. o Table name: TBHCFK83 o Target: National Health Insurance subscribers for the relevant year o Contents: Extract special calculation target for the relevant year and month, then exclude target and monitor changes in number of outpatient visits, treatment costs, etc. - Special calculation application classification code: 1: Cancer patients, 2: Rare and incurable, 3: Severe burns, 4: Severe dementia, 5: Rare/extremely rare, 6: Severely incurable, 7: Unknown rare, 8: Other chromosomal abnormality diseases 국민건강보험공단_합리적의료이용모니터링대상_산정특례대상자 National Health Insurance Corporation_Rational Medical Use Monitoring Target_Special Calculation Target 2024-08-13 2025-06-25 국민건강보험공단

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보건 - 건강보험 합리적의료이용,모니터링,건강보험,산정특례,TBHCFK83 rational use of medical care,Monitoring,Health Insurance,Special provisions for calculation,TBHCFK83 이용허락범위 제한 없음 수시 csv 2024-08-13 국민건강보험공단_합리적의료이용모니터링대상_산정특례대상자_20231231

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