J Korean Acad Nurs Adm.  2023 Dec;29(5):540-552. 10.11111/jkana.2023.29.5.540.

Recommending Revised Inpatient Nursing Fee Schedules Based on Actual Nurse Staffing Levels in General Wards

• Cho SH
• Kim J
• Seong J
• Lee JY

• KMID: 2549572
• DOI: http://doi.org/10.11111/jkana.2023.29.5.540

Abstract

Purpose
This study aims to propose revised inpatient nursing fee schedules that address three discrepancies between actual nurse staffing levels in general wards and the corresponding patient payment structures.
Methods
A total of 45 tertiary hospitals, 329 general hospitals, and 1,379 hospitals from publicly released data for 2021~2022 were analyzed. This analysis focused on three primary discrepancies between (1) the staffing grades under which patients were hospitalized and the corresponding grades for which they were charged; (2) the staffing grades determined by bed-to-nurse and patient-to-nurse criteria; and (3) the current differentiation rates of nursing fees and the expected differentiation rates based on the number of nurses required for each grade.
Results
The first discrepancy occurred in 8.9% of tertiary hospitals, 21.0% of general hospitals, and 26.0% of hospitals. The bed-to-nurse and patient-to-nurse grades differed by 2.23 and 2.29 grades on average in general hospitals and hospitals, respectively. The current differentiation rates were higher than the expected differentiation rates. New nursing fee schedules were suggested to resolve those discrepancies.
Conclusion
Nursing fees should be charged to reflect the staffing levels under which patients were cared for and proportionate to the number of nurses required to provide the corresponding staffing levels.

Keyword

General wards; Inpatient care fees; Nurses; Nursing fees; Staffing