J Nurs Acad Soc.  1990 Apr;20(1):16-37.

Determination of Nursing Costs for Hospitalized Patients Based on the Patient Classification System

• Park JH
• Song MS

Abstract

A cost analysis for hospitalized patients was camied out based upon Patient Classification System (PCS) in order to determine an appropriate nursing fee. The data were collected from 21 nursing units of three teaching hospitals from April 1 to June 30, 1989. First, all of the 22,056 inpatients were classified into mildly ill (Class I), moderately ill (Class II), acutely ill (Class III), and critically ill (Class IV) by the PCS which had been carefully developed to be suitable for the Korean nursing units. Second, PCS cost accounting was applied to the above data. The distribution of inpatients, nursing costs, and nursing productivity were as follows : 1) Patient distribution ranged from 45% to class I, 36% to class II, 15% to class III, and 4% to class IV, the proportion of class IV in 'H' Hospital was greater than that of the other two hospitals. 2) The proportion of Class III and IV in the medical nursing units was greater than that of surgical nursing units. 3) The number of inpatients was greatest on Tusedays, and least on Sundays. 4) The average nursing cost per hour was W 3,16 4 for 'S' hospital, W 3,511 for 'H' hospital and W 4, 824 for 'K'hospital. The average nursing cost per patient per day was W 14,126 for 'S' hospital, W 15, 842 for 'H' hospital and W 21,525 for 'K' hospital. 5) The average nursing cost calculated by the PCS was W 13,232 for class I, W 18,479 for class II, W 23,000 for class III, and W 25,469 for class IV. 6) The average nursing cost for the medical and surgical nursing units was W 13,180 and W 13,303 respectively for class I. W 18.248 and W 18.707 for class II, W 22,303 and W 23,696 for class III, and W 24,331 and W 26.606 for class IV . 7) The nursing costs were composed of 85% for wages and fringe benefits, 3% for material supplies and 12% for overhead. The proportion of wages and fringe benefits among the three hospitals ranged from 75%, 92% and 98% for the 'S', 'H', 'K' hospitals respectively, These findings explain why the average nursing cost of 'K' hospital was higher than the others. 8) According to a multi- regression analysis, wages and fringe benefits, material supplies, and overhead had an equal influence on determining the nursing cost while the nursmg hours had less influence. 9) The productivity of the medical nursing units were higher than the surgical nursing units, productivity of the D (TS) -nursing unit was the lowest while the K (Med)-nursing unit was the highest in 'S' hospital. In 'H" hospital, productivity was related to the number of inpatients rather than to the characte ristics of the nursing units. The 'K' hospital showed the same trend as 'S' hospital, that the productivity of the medical nursing unit was higher than the sur gical nursing unit. The productivity of 'S' hospital was evaluated the highest followed by 'H' hospital and 'K' hospital. Future research on nursing costs should be extended to the other special nursing areas such as pediatric and psychiatric nursing units, and to ICU or operating rooms. Further, the PCS tool should be carefully evaluated for its appropriateness to all levels of institutions (primary, secondary, tertiary). This study took account only of the quantity of nursing services when developing the PCS tool for evaluating the productivity of nursing units. Future research should also consider the quality of nursing services including the appropriateness of nursing activities.

MeSH Terms

Costs and Cost Analysis
*Economics, Nursing
Hospitalization/*economics
Humans
Korea
Patients/*classification