Browse > Article
http://dx.doi.org/10.11111/jkana.2013.19.5.565

Financial Projection of the Nursing Fee Differentiation Policy Improvement Proposal in the National Health Insurance: Using a Break-even Analysis Model for the Optimal Nursing Fee  

Kim, Sungjae (Department of Nursing, Seoul National University & The Research Institute of Nursing Science)
Kim, Jinhyun (Department of Nursing, Seoul National University & The Research Institute of Nursing Science)
Publication Information
Journal of Korean Academy of Nursing Administration / v.19, no.5, 2013 , pp. 565-577 More about this Journal
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.
Keywords
Hospital charges; Nursing staff; Nurse-patient relations; Financial management; Nursing administration research;
Citations & Related Records
Times Cited By KSCI : 4  (Citation Analysis)
연도 인용수 순위
1 Buchan, J., Bretherton, T., Bearfield, S., & Jackson, S. (2004). Stable but critical: The working conditions of Victorian public sector nurses in 2003. Sydney: University of Sydney.
2 American Nurse Association. (2013, July 15). Nurse staffing laws enacted in the states. Retrieved July 2, 2013, from http:// www.safestaffingsaveslives.org/WhatisANADoing/StateLe gislation/StaffingPlansandRatios.html
3 Buchan, J. (2005). A certain ratio? The policy implications of minimum staffing ratios in nursing. Journal of Health Services Research and Policy, 10, 239-247.   DOI   ScienceOn
4 Cho, S., & Yun, S. (2009). Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data. International Journal of Nursing Studies, 46, 1092-101. http://dx.doi.org/10.1016/j.ijnurstu.2009.02.001   DOI   ScienceOn
5 Cho, S., Hwang, J., Kim, Y., & Kim, J. (2006). Variations in nurse staffing in adult and neonatal intensive care units. Journal of Korean Academy of Nursing, 36, 691-700.
6 Cho, S., June, K., Kim, Y., & Park, B. (2008). Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. Journal of Korean Academy of Nursing Administration, 14 , 167-175.
7 Cho, S., Lee, H., Oh, J., & Kim, J. (2011). Inpatient outcomes by nurse staffing grade in Korea. Korean Journal of Health Policy & Administration, 21, 195-212. http://dx.doi.org/10. 4332/KJHPA.2011.21.2.195   DOI   ScienceOn
8 Health Insurance Review & Assessment Service & National Health Insurance Service. (2012). National Health Insurance Statistical Yearbook 2011. Seoul: Author.
9 Health Insurance Review & Assessment Service. (2010). Health insurance medical expenditure 2010. Seoul: Author.
10 Health Insurance Review & Assessment Service. (2011). Improvement project of scoring criteria in nursing fee differentiation policy. Seoul: Author.
11 Hwang, N., Choi, B., Park, H., & Kim, D. (2006). The social institutionalization of nursing care service in Korean medical institutions. Seoul: Korea Institute for Health and Social Affairs.
12 Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wil,t T. J. (2007). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45, 1195-1204. http://dx.doi.org/10.1097/MLR. 0b013e3181468ca3   DOI   ScienceOn
13 Kim, J., & Kim, S. (2012). A proposal to improve nursing fee differentiation policy for general hospitals using profitabilityanalysis in the national health insurance. Journal of Korean Academy of Nursing, 42, 351-360. http://dx.doi.org/10. 4040/jkan.2012.42.3.351   DOI   ScienceOn
14 Kim, J., Kim, S., & Park, B. (2011). Realization project in nursing fee differentiation policy. Seoul: Seoul National University & Korean Nurses Association.
15 Kim, J., Nam, H., Sung, Y., Park, K., & Park, H. (2008). A survey for developing strategies to improve the fees for nursing care. Journal of Korean Clinical Nursing Research, 14 (1), 5-14.
16 Kim, J., Park, S., Kim, M., Sung, Y., Park, K., Kim, S., et al. (2009). The effect of nursing grades on a hospital's financial performance in nursing fees differentiation policy. Seoul: Seoul Nurses Association.
17 Kim, Y., & Hong, J. (2007). A research on the actual condition of workforce and salary in health industry. Seoul: Korean Confederation of Trade Unions & Korea Health and Medical Workers' Union.
18 Kim, Y., Cho, S., June, K., Shin, S., & Kim, J. (2012). Effects of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients. Journal of Korean Academy of Nursing, 42 (5), 719-729. http:// dx.doi.org/10.4040/jkan.2012.42.5.719   DOI   ScienceOn
19 Lee, Y., Park, K., Jung, H., Kim, C., Lee, S., & Korean Hospital Association. (2008). Policy debate to solve the nursing shortage. Journal of the Korean Hospital Association, 315 , 46- 50.
20 Korean Nurses Association. (2011, June 21). Public hearing for improvement project in nursing fee differentiation policy. Seoul: Author.
21 Ministry of Health & Welfare. (2012, March 27). Notification No. 2012-39 of the Ministry of Health & Welfare. Retrieved July 2, 2013, from http://www.mw.go.kr/front_new/jb/sjb0402 vw.jsp?PAR_MENU_ID=03&MENU_ID=030402&page=11& CONT_SEQ=268952&SEARCHKEY=ALT_NO&SEARCHVA LUE=2012
22 O, D., & Lee, Y. (2009). The study of conversion factor for health insurance contracts for 2010. Seoul: Korean Hospital Association.
23 O, D., Kang, G., Kim, J., Jung, Y., & Lee, Y. (2006). The study about cost-analysis and optimal level of hospitalization fee according to types of medical institutions. Cheonam: Research Institute of Industrial Sciences and Sangmyung University.
24 Scott, C. (2003). Setting safe nurse staffing levels: An exploration of the issues. Research Fellow. London: RCN Institute.
25 The National Assembly of the Republic Korea. (2013). Chapter 3 Clause 3 of the Korean Medical Law. Retrieved July 15, 2013, from http://likms.assembly.go.kr/law/jsp/Law.jsp? WORK_ TYPE=LAW_BON&LAW_CHECK=TRUE&LAW_ID=A1549 &PROM_NO=10387&PROM_DT=20100723&SRCHK=Y
26 Yom, Y., Koh, M., Kim, K., Kim, T., Min, S., Park, J., et al. (2009). Nursing Management(5th ed.). Seoul: Soomoonsa.
27 You, S., Choi, Y., Kim, H., Park, B., Chang, H., & Park, J. (2006). Development of a inpatient health care service model for job creation. Seoul: Korea Health Industry Development Institute.