Korean J Rehabil Nurs.  2021 Jun;24(1):1-14. 10.7587/kjrehn.2021.1.

A Study on the Status of Application of Health Insurance Fees for Nursing Activities of Nurses in Rehabilitation Unit

• Yee OH
• Kim SH
• Cho M
• Moon KH
• Lee S

• KMID: 2519106
• DOI: http://doi.org/10.7587/kjrehn.2021.1

Abstract

Purpose
The purpose of this study was to analyze the nursing activities of registered nurses working in rehabilitation units, and to investigate the application of the health insurance fee for each nursing practice.
Methods
Using the Delphi survey method, nursing activities were analyzed as job-task-task elements. Then, the status of the application of health insurance fees was investigated for the task elements according to National Health Insurance Benefit.
Results
15 jobs, 61 tasks, and 290 task elements were derived as nursing activities in rehabilitation units. According to the opinion by the expert panel, Among the 290 task elements, 166 (57.2%) out of 290 take elements should be accepted as insurance fees (fee agreement CVR≥0.56). However, the health insurance was applied to only 40 items (24.1%) for nursing management fees, 25 items for nursing care (15.1%), and 26 items for other rehabilitation related medical fees (15.7%). 82 items (49.4%) were not covered by insurance, and most educational interventions were not covered.
Conclusion
To provide high-quality nursing services in rehabilitation units, it is essential to apply an appropriate level of health insurance coverage. Further research to expand the application of medical fees related to rehabilitation and institutional arrangements to obtain recognition of the fees for nursing services are necessary.

Keyword

Rehabilitation nursing; National health Insurance; Fees