J Korean Clin Nurs Res.
2017 Aug;23(2):236-247. 10.22650/JKCNR.2017.23.2.236.
A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices
- Affiliations
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- 1Professor, College of Nursing, Eulji University, Korea.
- 2Associate Professor, Department of Nursing, Namseoul University, Korea. kgs4321@nsu.ac.kr
- 3Head of Nursing, Department of Nursing, Aju University Hospital, Korea.
- 4Manager, Division of Nursing, Gangnam Sevrance Hospital, Korea.
- 5Assistant Professor, College of Nursing, Eulji University, Korea.
- KMID: 2397661
- DOI: http://doi.org/10.22650/JKCNR.2017.23.2.236
Abstract
- PURPOSE
This study was to present improvement strategy and the problems of the nursing fee in national health insurance system.
METHODS
A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance.
RESULTS
Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis.
CONCLUSION
This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.
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