J Nurs Acad Soc.  1993 Mar;23(1):68-89.

Development of a Nursing Fee Schedule Model

• Cho SY
• Park JH

Abstract

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 tor 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 mumber 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, A5, A6, A7, A8) 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 A5=the type of hospital management (profit/non-profit) A6=number of hospital beds A7=years of hospital operation A8=number and kinds of clinical divisions The results showed that the model should be built as follows: C=f (A1. A4. A5) 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 recornmened 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.

MeSH Terms

Classification
Delivery of Health Care
Fee Schedules*
Fees and Charges*
Humans
Insurance, Health
Insurance, Health, Reimbursement
Korea
Nursing Service, Hospital
Nursing Services
Nursing*
Referral and Consultation
Research Personnel
Salaries and Fringe Benefits