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Yoon and Kim: Activity-Based Costing Analysis of Nursing Activities in General Hospital Wards
Original Article

Journal of Korean Academy of Nursing Administration 2013; 19(4): 449-461.

Published online: 30 September 2013

DOI: https://doi.org/10.11111/jkana.2013.19.4.449

Activity-Based Costing Analysis of Nursing Activities in General Hospital Wards

Ho-Soon Yoon1, Jinhyun Kim2

1National Health Insurance Cooperation Ilsan Hospital, Korea.

2College of Nursing·The Research Institute of Nursing Science, Seoul National University, Korea.

Corresponding author: Kim, Jinhyun. College of Nursing·The Research Institute of Nursing Science, Seoul National University, Seoul 100-744, Korea. Tel: +82-2-740-8818, Fax: +82-2-6280-0781, jinhyun@snu.ac.kr

Received 11 March 2013       Revised 10 May 2013       Accepted 21 August 2013

Copyright © 2013 Korean Academy of Nursing Administration

Abstract

Purpose

The purpose of this study was to explore the relationship between cost and revenue for inpatient nursing activities in general wards.

Methods

Data were collected from 12 medical-surgical wards in one general hospital from January 1 to December 31, 2010. The nursing activities were categorized into 2 groups according to nursing service payment type in terms of the Korea health insurance system. Descriptive statistics were used to identify nursing activities and nursing activity costs.

Results

Of 140 nursing activities identified as performed in general wards, payment for 69 items was included in nursing management fees. The percentage of each cost for the nursing units was 90% for labor, 4% for materials, and 6% for operating expenses. The cost for medical support nursing service accounted for 38% of costs and nursing management fees, 62%. The average profit and loss was -237,257,000 won. The cost recovery rate for nursing service was only 44%.

Conclusion

The results indicate a need to measure the economic value of nursing activities performed in general wards and use it as a basis for establishing an adequate reimbursement system for nursing service.

Keywords: Nursing fee, Cost analysis, Nursing cost

Figures and Tables

Table 1
Framework of Nursing Activity Classification by Insurance System Payment Type
jkana-19-449-i001
Table 2
Time Spent & Cost Driver Rate for Nursing Activities
jkana-19-449-i002

EKG=Electrocardiogram; BP=Blood Pressure; EVD=Extra Ventricular Drainage; VRE=Vancomycin Resistant Enterococci; MRSA=Methicylin Resistant Staphylococcus aureus; PTBD=Percutanous Transhepatic Biliary Drainage; OCS=Order Communication System; CSR=Central Sterilization Room; SPD=Supply Purchasing Department †Assigned cost/activity quantity; *Activity applied cost per day; **Activity applied cost per month: Cost revised to activity quantity×15 (average nursing staff in a unit)

Table 3
Assigned Cost Ratio by Payment Type in Nursing Domains
jkana-19-449-i003
Table 4
Revenue from Inpatient Fees by Ward (\1,000)
jkana-19-449-i004
Table 5
Cost-Volume-Profit Analysis (\1,000)
jkana-19-449-i005

TNS=Total Nurses' Salaries; MATC=Material Cost; EXP=Expense Used in Nursing Unit; PINAC=Nursing Activity Cost for Medical Service Paid Independently; MNAC=Nursing Activity Cost included in Nursing Management fee; DPINAC=Distributed Cost for PINAC=PINAC+MATC×Proportion of PINAC+EXP×proportion of PINAC; DMNAC=Distributed Cost for MNAC=MNAC+MATC×Proportion of MNAC+EXP×Proportion of MNAC; NMF=Nursing Management Fee (Income); L/P=Loss & Profit for Nursing Unit=NMF-DMNAC.

Notes

This article is based on a part of the first author's doctoral dissertation from Seoul National University.

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