J Korean Acad Nurs Adm.  2013 Dec;19(5):565-577.

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 S
• Kim J

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.

Keyword

Hospital charges; Nursing staff; Nurse-patient relations; Financial management; Nursing administration research

MeSH Terms

Consensus
Fees and Charges*
Financial Management
Health Expenditures
Hospital Charges
Hospitalization
Hospitals, General
Humans
Insurance, Health
Jurisprudence
Methods
National Health Programs*
Nurse-Patient Relations
Nursing Administration Research
Nursing Staff
Nursing*
Public Opinion
Tertiary Care Centers

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