1National Health Insurance Cooperation Ilsan Hospital, Korea.
2College of Nursing·The Research Institute of Nursing Science, Seoul National University, Korea.
Corresponding author: Kim, Jinhyun. College of Nursing·The Research Institute of Nursing Science, Seoul National University, Seoul 100-744, Korea. Tel: +82-2-740-8818, Fax: +82-2-6280-0781, jinhyun@snu.ac.kr
• Received: March 11, 2013 • Revised: May 10, 2013 • Accepted: August 21, 2013
The purpose of this study was to explore the relationship between cost and revenue for inpatient nursing activities in general wards.
Methods
Data were collected from 12 medical-surgical wards in one general hospital from January 1 to December 31, 2010. The nursing activities were categorized into 2 groups according to nursing service payment type in terms of the Korea health insurance system. Descriptive statistics were used to identify nursing activities and nursing activity costs.
Results
Of 140 nursing activities identified as performed in general wards, payment for 69 items was included in nursing management fees. The percentage of each cost for the nursing units was 90% for labor, 4% for materials, and 6% for operating expenses. The cost for medical support nursing service accounted for 38% of costs and nursing management fees, 62%. The average profit and loss was -237,257,000 won. The cost recovery rate for nursing service was only 44%.
Conclusion
The results indicate a need to measure the economic value of nursing activities performed in general wards and use it as a basis for establishing an adequate reimbursement system for nursing service.
This article is based on a part of the first author's doctoral dissertation from Seoul National University.
REFERENCES
1. Cho SH, June KJ, Kim YM, Park BHJ. Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. J Korean Acad Nurs Adm. 2008;14:167-175.
2. Health Insurance Review & Assessment Service. Study on revised relative value scale. Seoul: Author; 2006.
3. Im GJ, Min HY, Choi JW, Lim SM, Park YH. Financial state of primary care physicians under the Korean insurance system. J Korean Med Assoc. 2011;54(1):98-111. http://dx.doi.org/10.5124/jkma.2011.54.1.98
4. Jang JB. A study on estimation of the costs incurred by ED nursing activities by applying the activity based costing. Seoul, Korea: Ewha Womans University; 2004. Unpublished master's thesis.
5. Joo SJ. The application of ABC system. Paju Book City: KSI Publishing Company; 2007.
6. Jung SC, Na JI, Lee KT. The practical use of ABC system in NHIC Ilsan hospital. Gwallihoegyeyeongu. 2011;11(1):113-146.
7. Kang KH. Analysis of nursing activities and cost of nursing service based on the ABC system. J Korean Acad Nurs Adm. 1999;5:389-400.
8. Kaplan RS, Anderson SR. Time-driven activity-based costing. Harv Bus Rev. 2004;82:131-138.
9. Kim EK, Kim YM, Kim MA. Estimation of nursing costs based on nurse visit time for long-term care services. J Korean Acad Nurs. 2010;40:349-358. http://dx.doi.org/10.4040/jkan.2010.40.3.349
10. Kim IS, Kang KH, Lee HJ, Kim MJ, Kang SJ, Joo YM. Cost analysis of nursing service in the delivery room using activity-based costing. J Korean Acad Nurs Adm. 2002;8:17-29.
11. Kim YM. Analysis of tendency on staffing & work condition for Korean hospital nurses, Annual Report, 255-308. Seoul: Korean Hospital Nurses Association; 2011.
12. Kim YM, Nam HK, Sung YH, Park KO, Park HO. A survey for developing strategies to improve the fees for nursing care. J Korean Clin Nurs Res. 2008;14(1):5-14.
13. Korean Hospital Association. Study on revised relative value scale for basic medical fee. Seoul: Author; 2009.
14. Korean Nurses Association. 2007 yearbook of nursing statistics. Seoul: Author; 2007.
15. Lee SJ. Cost analysis of home care with activity-based costing(ABC). J Korean Acad Nurs. 2004;34:1117-1128.
16. Lim JY. An analysis of cost and profit of a nursing unit using performance-based costing: Case of a general surgical ward in a general hospital. J Korean Acad Nurs. 2008;38:161-171. http://dx.doi.org/10.4040/jkan.2008.38.1.161
17. Lim JY, Yoo SW. The trends of cost analysis on nursing services. J Korean Acad Nurs Adm. 2007;13:407-420.
18. Lim JY, Kim MJ, Park CG. Analysis of cost and efficiency of a medical nursing unit using time-driven activity-based costing. J Korean Acad Nurs. 2011;41:500-509. http://dx.doi.org/10.4040/jkan.2011.41.4.500
19. McCloskey JC. Implications of costing out nursing services for reimbursement. Nurs Manage. 1989;20(1):44-46. 48-49.
20. Oh DI. Cost analysis and charges for inpatients in the Korean hospitals. Seoul: Sangmyung Institute of Industrial Science; 2006.
21. Park JH, Sung YH, Park KO, Kim YM, Nam HK, Kim KS. Measurement and analysis of the standard nursing practice times of the reference nursing activities. Clin Nurs Res. 2006;12(2):17-29.
22. Park JH, Sung YH, Song MS, Cho JS, Sim WH. The classification of standard nursing activities in Korea. J Korean Acad Nurs. 2000;30:1411-1426.
23. Park JH, Hwangbo SJ, Lee ES. Identification of nursing activities for determination of cursing cost. J Nurs Acad Soc. 1992;22:185-206.
24. Park SH. Analysis of direct nursing activity and patient outcomes related to graded fee of nursing management for inpatient. J Korean Acad Nurs. 2003;33:122-129.
28. Whang NM. The way of social institutionalization for carer services in the health care system. Seoul: The Korean Ministry of Gender Equality & Family; 2006.
29. Yook KH. A comparative study of recent development of hospital cost accounting in UK, US, and Japan. Korean J Hosp Manage. 2007;12(3):20-45.
Table 1
Framework of Nursing Activity Classification by Insurance System Payment Type
Table 2
Time Spent & Cost Driver Rate for Nursing Activities
EKG=Electrocardiogram; BP=Blood Pressure; EVD=Extra Ventricular Drainage; VRE=Vancomycin Resistant Enterococci; MRSA=Methicylin Resistant Staphylococcus aureus; PTBD=Percutanous Transhepatic Biliary Drainage; OCS=Order Communication System; CSR=Central Sterilization Room; SPD=Supply Purchasing Department †Assigned cost/activity quantity; *Activity applied cost per day; **Activity applied cost per month: Cost revised to activity quantity×15 (average nursing staff in a unit)
Table 3
Assigned Cost Ratio by Payment Type in Nursing Domains
Table 4
Revenue from Inpatient Fees by Ward (\1,000)
Table 5
Cost-Volume-Profit Analysis (\1,000)
TNS=Total Nurses' Salaries; MATC=Material Cost; EXP=Expense Used in Nursing Unit; PINAC=Nursing Activity Cost for Medical Service Paid Independently; MNAC=Nursing Activity Cost included in Nursing Management fee; DPINAC=Distributed Cost for PINAC=PINAC+MATC×Proportion of PINAC+EXP×proportion of PINAC; DMNAC=Distributed Cost for MNAC=MNAC+MATC×Proportion of MNAC+EXP×Proportion of MNAC; NMF=Nursing Management Fee (Income); L/P=Loss & Profit for Nursing Unit=NMF-DMNAC.
Figure & Data
References
Citations
Citations to this article as recorded by
An exploratory study of nursing tasks that induce physical and mental stress among hospital nurses Younhee Kang, Aekyeong Jin Applied Nursing Research.2024; 80: 151853. CrossRef
Research Trends Review of Financial Performance in Hospitals Wonjung Noh, Ji Young Lim, Gyeong Ae Seomun, Miyoung Kim, Soyoung Yu, Yoomi Jung, Youngjin Lee Journal of Korean Academy of Nursing Administration.2023; 29(1): 76. CrossRef
A Study on the Status of Application of Health Insurance Fees for Nursing Activities of Nurses in Rehabilitation Unit Oon Hee Yee, Sun-Houng Kim, Mihwa Cho, Kyung Hee Moon, Seungyoung Lee The Korean Journal of Rehabilitation Nursing.2021; 24(1): 1. CrossRef
The Current and Future State of Academic Medicine in Korea: Education, Research, and Patient Care Dae Chul Jeong Korean Medical Education Review.2019; 21(2): 73. CrossRef
Association of nurse staffing grade and 30-day mortality in intensive care units among cardiovascular disease patients Jae-Hyun Kim Medicine.2018; 97(42): e12895. CrossRef
Analysis of Nurses’ Soothing Behaviors in Neonatal Intensive Care Unit: Focused on Babies with Bronchopulmonary Dysplasia Yu-Nah Lee, Hyunsook Shin Child Health Nursing Research.2017; 23(4): 494. CrossRef
Effect of nurse staffing variation and hospital resource utilization Yunmi Kim, Seon‐Ha Kim, Young Ko Nursing & Health Sciences.2016; 18(4): 473. CrossRef
Activity-Based Costing Analysis of Nursing Activities in General Hospital Wards
Activity-Based Costing Analysis of Nursing Activities in General Hospital Wards
Framework of Nursing Activity Classification by Insurance System Payment Type
Time Spent & Cost Driver Rate for Nursing Activities
EKG=Electrocardiogram; BP=Blood Pressure; EVD=Extra Ventricular Drainage; VRE=Vancomycin Resistant Enterococci; MRSA=Methicylin Resistant Staphylococcus aureus; PTBD=Percutanous Transhepatic Biliary Drainage; OCS=Order Communication System; CSR=Central Sterilization Room; SPD=Supply Purchasing Department †Assigned cost/activity quantity; *Activity applied cost per day; **Activity applied cost per month: Cost revised to activity quantity×15 (average nursing staff in a unit)
Assigned Cost Ratio by Payment Type in Nursing Domains
Revenue from Inpatient Fees by Ward (\1,000)
Cost-Volume-Profit Analysis (\1,000)
TNS=Total Nurses' Salaries; MATC=Material Cost; EXP=Expense Used in Nursing Unit; PINAC=Nursing Activity Cost for Medical Service Paid Independently; MNAC=Nursing Activity Cost included in Nursing Management fee; DPINAC=Distributed Cost for PINAC=PINAC+MATC×Proportion of PINAC+EXP×proportion of PINAC; DMNAC=Distributed Cost for MNAC=MNAC+MATC×Proportion of MNAC+EXP×Proportion of MNAC; NMF=Nursing Management Fee (Income); L/P=Loss & Profit for Nursing Unit=NMF-DMNAC.
Table 1
Framework of Nursing Activity Classification by Insurance System Payment Type
Table 2
Time Spent & Cost Driver Rate for Nursing Activities
EKG=Electrocardiogram; BP=Blood Pressure; EVD=Extra Ventricular Drainage; VRE=Vancomycin Resistant Enterococci; MRSA=Methicylin Resistant Staphylococcus aureus; PTBD=Percutanous Transhepatic Biliary Drainage; OCS=Order Communication System; CSR=Central Sterilization Room; SPD=Supply Purchasing Department †Assigned cost/activity quantity; *Activity applied cost per day; **Activity applied cost per month: Cost revised to activity quantity×15 (average nursing staff in a unit)
Table 3
Assigned Cost Ratio by Payment Type in Nursing Domains
Table 4
Revenue from Inpatient Fees by Ward (\1,000)
Table 5
Cost-Volume-Profit Analysis (\1,000)
TNS=Total Nurses' Salaries; MATC=Material Cost; EXP=Expense Used in Nursing Unit; PINAC=Nursing Activity Cost for Medical Service Paid Independently; MNAC=Nursing Activity Cost included in Nursing Management fee; DPINAC=Distributed Cost for PINAC=PINAC+MATC×Proportion of PINAC+EXP×proportion of PINAC; DMNAC=Distributed Cost for MNAC=MNAC+MATC×Proportion of MNAC+EXP×Proportion of MNAC; NMF=Nursing Management Fee (Income); L/P=Loss & Profit for Nursing Unit=NMF-DMNAC.
