• Journal of Korean Academy of Nursing
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• v.23 no.1
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• pp.68-89
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• 1993

This study was conducted to develop a model of a fee schedule for nursing services.'Regardless of the demand for skilled and professional nursing service today, the Korean health insurance system does not furnish a chapter for the nursing service fee schedule. A nation-wide survey of hospital nursing service fee schedules was to provide practical and realistic data about how the variety of nursing services are being charged. From September 1990 to April 1991, data from the fee schedule used by twenty hospitals located in eight large cities which are designated large medical regions in the Korea Health Care and Patient Referral System were collected. Nursing services and the fees charged for them were analyzed. The nursing services were subjected to a secondary analysis with referrence to reports on “nursing services to be charged in Korea”. The total number of nursing services recommended by the literatures was 177 : finally 141 types of nursing services were selected by investigator as chargable nursing services. In addition, data on managerial characteristics of the hospitals were collected to discover influential variables for a nursing fee schedule model. Under the assumption that all the managerial characteristics of the hospitals influenced the fee schedule, the following model was tested : Fee of nursing services (C) = f(A₁, A₂, A₃, A₄, A/sub 5/, A/sub 6/, A/sub 7/, A/sub 8/,) When, A₁ = number of nurses A₂ = the first salary of a nurse educated in a four year A₃ = scale of nursing management division A₄ = location of the hospital A/sub 5/ = the type of hospital management (profit / non-profit) A/sub 6/ = number of hospital beds A/sub 7/ = years of hospital operation A/sub 8/ = number and kinds of clinical divisions The results showed that the model should be built as follows : C = f (A₁, A/sub 4/, A/sub 5/) Each nursing service was applied to the fee schedule with consideration for the professional level and time-taken to provide the services. Detailed fee schedules were presented in the related tables. Of the 141 kinds of nursing services, 24.8% were chargeble to the Korea Health Insurance, 32.6％ of the nursing services were being paid directly by the patienty. The rest of nursing services (42.6％) were not being charged to any source. It was recommened that the Korea Health Insurance Reimbursement system should add a classification system for nursing services that can be used in the national health care program. Further study is needed about how to include 32.6% of the nursing services now being paid for directly by the patients in the health insurance system.

• Journal of Korean Public Health Nursing
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• v.3 no.2
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.3
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• pp.379-389
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• 2003

Purpose: The objective of our study was to figure out costs of nursing services in general nursing units based on the PCS in order to determine an appropriate nursing fee schedule. Method: The data were collected from 8 hospitals from September 9 to October 8, 2002. The costs of nursing services in general nursing units was analyzed by nursing hours based on the nursing intensity. The inpatient in the general nursing units were classified by Park's PCS tool(2000). Results: The distribution of patients by PCS ranged from class I to Class III in general nursing units. The higher PCS in general nursing units consumed more nursing hours. As a result, the higher nursing intensity, the more the daily average nursing costs in general nursing units. Conclusion: We found that the higher PCS, the more the daily average nursing costs in general nursing units. In conclusion, our study provides the evidence to refine the current nursing fee schedule that it does not differentiated from the volume of nursing services based on the nursing hours.

• Journal of Korean Public Health Nursing
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• v.2 no.2
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• pp.21-44
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• 1988

In Korea, fee-for service reimbursement has been adopted from the begining of medical insurance system in 1977, and the importance of the relative value unit is currently being investigated. The purpose of this study was to find out the level of propriety of the difference in the fees for different surgical services, and the appropriateness of the classification of the insurance fee schedule. For the purpose of this study, specific subjects and the procedural methodology is shown as follows: 1. The propriety of the Relative Price System(RPS). 1) Choice of sample operations. In this study, sample operations were selected and classified by specialists in general surgery, and the number of items they classified were 32. For the same group of operations the Insurance Fee Schedule(IFS) classified the operations into 24 separate items. In order to investigate the propriety of the RPS, one of the purpose of this study, was to examine the 24 items classified by the IFS. 2) Evaluation of the complexity of surgery. The data used in this study was collected The data used in this study was collected from 94 specialists in general surgery by mail survey from November I to 15, 1986. Several independent variables (age, location, number of bed, university hospital, whether the medical institution adopt residents or not) were also investigated for analysis of the characteristics of surgical complexity. 3) Complexity and time calculations. Time data was collected from the records of the Seoul National University' Hospital, and the cost per operation was calculated through cost finding methods. 4) Analysis of the propriety of the Relative Price System of the Insurance Fee Schedule. The Relative Price System of the sample operation was regressed on the cost, time, comlexity relative ,value system (RVS) separately. The coefficient of determination indicates the degree of variation in the RPS of the Insurance Fee Schedule explained by the cost, time, complexity RVS separately. 2. The appropriateness of the classification of the Insurance Fee Schedule. 1) Choice of sample operations. The items which differed between the classification of the specialist and the classification of medical, Insurance Fee Schedule were chosen. 2) Comparisons of cost, time and complexity between the items were done to evaluate which classification was more appropriate. The findings of the study can be summarized as follows: 1. The coefficient of determination of the regression of the RPS on-cost RVS was 0.58, on time RVS was 0.65, and on complexity RVS was 0.72. This means that the RPS of Insurance Fee Schedule is improper with respect to the cost, time, complexity separately. Thus this indicates that RPS must be re-shaped according to the standard element. In this study, the correlation coefficients of cost, time, complexity Relative Value System were very high, and this suggests that RPS could be reshaped I according to anyone standard element. Considering of measurement, time was thought to be the most I appropriate. 2. The classifications of specialist and of the Insurance Fee Schedule were compared with respect to cost, time, and complexity separately. For complexity, ANOVA was done and the others were compared to the different values of different classifications. The result was that the classification of specialist was more reasonable and that the classification of Insurance Fee Schedule grouped inappropriately several into one price unit.

• Journal of Korean Academy of Nursing
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• v.37 no.3
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• pp.373-380
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• 2007

Purpose: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. Method: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). Results: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. Conclusion: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.

• Journal of Korean Academy of Nursing
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• v.30 no.6
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• pp.1580-1591
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• 2000

This study was conducted to assess the amount of nursing services for psychiatric inpatients and to estimate psychiatric nursing costs by using the RBRVS. Full details of medical services, including physician and nursing services, for psychiatric inpatients were surveyed and data of general characteristics of hospitals and patients were also collected. The cost of nursing activities was estimated by the multiple conversion factor which was drawn from the Korean RBRVS Development Project to the RBRVS score of each nursing activities, which was drawn from the results of Korean Nurses Association (KNA)'s projects about nursing RBRVS development and cost of nursing activities. The data about 89 inpatients from 3 general hospitals with psychiatric departments were analyzed. The total cost of nursing activities for each patient per admission day was from KRW 22,185 to KRW 27,954 by hospital, and KRW 25,220 in average. The percent of nursing cost to the total cost of medical services was from 36% to 48% by characteristics of patients and 41.4% in average. The cost of nursing activities estimated in this study was between the existing NHI fee schedule and the one suggested by KNA. It is considered as appropriate and acceptable level compared to the total amount of medical services. In the process of KNA's activities to get nursing fee in NHI fee schedule, results of additional studies to estimate the cost of nursing activities balanced with total cost of medical services in every departments should be found and utilized.

• Journal of Korean Academy of Nursing Administration
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• v.5 no.2
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• pp.253-280
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• 1999

A cost analysis for hospitalized patients was performed based on the RBRVS in order to determine an appropriate nursing fee schedule. The study was conducted through three phases as follows: 1) Nursing activities provided for the inpatients currently in Korea were identified and classified using a taxonomy which was developed by our research team through the Delphi process. 2) The resource-based relative points for every nursing activity according to nursing time, mental effort and judgement, technical skill, physical effort and stress were determined through a survey of 300 clinical RNs working at 5 tertiary hospitals from May 25 to July 25. 1998. 3) The nursing cost of every nursing activity for hospitalized patients was estimated based on the RBRVS. As a result, 136 nursing activities were identified and classified by nursing processes and nursing domains. However, our classification system of nursing activities should continue to be refined, and all nursing practices should be standardized. The nursing activities were given resource-based relative points ranging from 100 to 400 points, then each nursing activity was assigned a value for the RBRVS, which was determined by the exponential function of 2resource-based relative point/100. Thus, a value of 2 was calculated for 100 points, 4 for 200 points, 8 for 300 points, and 16 for 400 points. Meanwhile, the unit cost of nursing was calculated as 170 Won. The nursing cost of 136 nursing activities was estimated using the RBRVS as shown in