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Abstract
Purpose
This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act.
Methods
The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift.
Results
Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%.
Conclusion
The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.
Figures and Tables
Table 1
Total Number of Medical Institutions, Beds, RNs, and Patients Days in the Third Quarter for Corresponding Nursing Grades
Table 2
Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institutions
TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.
*SubtotalⒼ Annual health insurance expenditure of hospitalization fees for each nursing grade; †SubtotalⓉ Annual health insurance expenditure of hospitalization fees for each type of medical institution; ‡Percentage ChangeⒼ Percentage change of hospitalization fee in between each grade and standard grade; §Percentage ChangeⓂ Percentage change of annual hospitalization fees in between current expenditure system and modified system.
Table 3
Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institution
TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.
*SubtotalⒼ Annual health insurance expenditure of hospitalization fees for each nursing grade; †SubtotalⓉ Annual health insurance expenditure of hospitalization fees for each type of medical institution; ‡Percentage ChangeⒼ Percentage change of hospitalization fee in between each grade and standard grade; §Percentage ChangeⓂ Percentage change of annual hospitalization fees in between current expenditure system and modified system.
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