@article{oai:niigata-u.repo.nii.ac.jp:00019402,
 author = {小池, 昭彦},
 issue = {4},
 journal = {新潟医学会雑誌, 新潟医学会雑誌},
 month = {Apr},
 note = {Medical insurance institution in Japan is running based on the system with payment at piece rates. It has been disclosed that this system has both advantages and disadvantages, and on its practical applications reviewing commitees are assigned to deal with details. On submission of insurance claims, they are inspected for their documental formalities and then documented medical practices are examined for their suitability in a course of primary assesment. Some claims are reduced or returned for improvement of documentation in the process of assessment. In Niigata prefecture, the rate of return is the highest in Japan and the incidence of reduction is low, which probably reflects our efforts to avoid economical losses for medical institutes by returning and letting incomplete claims be improved. In addition to this, there are an increasing number of requests for re-assessment made by insurers after the completion of primary assessment, which is one of the biggest problems in the current system. Most problems in the current system of insurance assessment come from the fact that the current medical insurance institution is not based on theoretical background but is constructed on arbitrary agreements. It is, therfore, the most important issue for the commitee to reduce inconsistency in the current system and rebuild it in a more scientific manner.},
 pages = {274--282},
 title = {5) 審査の現状とあり方(シンポジウム 保険医療をめぐる諸問題, 第489回新潟医学会総会）},
 volume = {108},
 year = {1994}
}