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

Sungjae Kim; Jinhyun Kim

doi:10.11111/jkana.2013.19.5.565

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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

Sungjae Kim, Jinhyun Kim

Journal of Korean Academy of Nursing Administration 2013;19(5):565-577.
Published online: December 31, 2013

DOI: https://doi.org/10.11111/jkana.2013.19.5.565

Department of Nursing, Seoul National University & The Research Institute of Nursing Science, Korea.

Corresponding author: Kim, Jinhyun. Department of Nursing, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul 110-744, Korea. Tel: +82-11-590-7582, Fax: +82-2-747-3948, jinhyun@snu.ac.kr

• Received: July 26, 2013 • Revised: September 2, 2013 • Accepted: September 5, 2013

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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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.
Key Words: Hospital charges; Nursing staff; Nurse-patient relations; Financial management; Nursing administration research

Article Information

This study was financially supported by the Korean Nurses Association.

REFERENCES

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Table 1

Total Number of Medical Institutions, Beds, RNs, and Patients Days in the Third Quarter for Corresponding Nursing Grades

Note. Range between the grades (-) means 'more than x.x-less than y.y'.

Inst=Institutions; RNs=Registered Nurses; DOH=Days of hospitalization; TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

^†Standard.

Table 2

Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institutions

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

^*SubtotalⒼ Annual health insurance expenditure of hospitalization fees for each nursing grade; ^†SubtotalⓉ Annual health insurance expenditure of hospitalization fees for each type of medical institution; ^‡Percentage ChangeⒼ Percentage change of hospitalization fee in between each grade and standard grade; ^§Percentage ChangeⓂ Percentage change of annual hospitalization fees in between current expenditure system and modified system.

Table 3

Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institution

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

Figure & Data

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Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design
Hyun-Joo Kim, Sun-Hee Lee, Jai-Jung Lee, Sun-Suk Seong, Hee Yang, Hyang-Yuol Lee
Journal of Korean Academy of Nursing.2024; 54(2): 237. CrossRef
Impact of a financial incentive policy on Korean nurse staffing
Y. Kim, J. Kim
International Nursing Review.2015; 62(2): 171. CrossRef

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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

J Korean Acad Nurs Adm. 2013;19(5):565-577. Published online December 31, 2013

DOI: https://doi.org/10.11111/jkana.2013.19.5.565

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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

J Korean Acad Nurs Adm. 2013;19(5):565-577. Published online December 31, 2013

DOI: https://doi.org/10.11111/jkana.2013.19.5.565

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

Table 1

Total Number of Medical Institutions, Beds, RNs, and Patients Days in the Third Quarter for Corresponding Nursing Grades

Note. Range between the grades (-) means 'more than x.x-less than y.y'.

Inst=Institutions; RNs=Registered Nurses; DOH=Days of hospitalization; TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

^†Standard.

Table 2

Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institutions

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

Table 3

Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institution

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

Table 1 Total Number of Medical Institutions, Beds, RNs, and Patients Days in the Third Quarter for Corresponding Nursing Grades

Note. Range between the grades (-) means 'more than x.x-less than y.y'.

Inst=Institutions; RNs=Registered Nurses; DOH=Days of hospitalization; TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

^†Standard.

Table 2 Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institutions

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

Table 3 Hospitalization Fees and Health Insurance Expenditure according to Nursing Grade for Type of Medical Institution

TH=Tertiary hospitals; GH=General hospitals; H=Hospitals; UD=Undeclared Institutions.

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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

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