The current medical insurance fee schedule is based on the medical feeforservice system, and nursing costs are not adequately carted.
The purpose of this study was to develop a system for estimation of nursing costs and to validate that system. The study took place in three medical nursing units in FSJ National University Hospital from April 1 to June 30,
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A total of 486 patients who were hospitalized, in the units were the subjects of this study. 62 patients were included for the investigation of nursing care hours and prime costs, and 42. patients were subjects for estimation of total nursing costs based on the most frequent , Korean Diagnosis Related Groups (K-DRGs).
Two measurement system, K-DRGs which have been developed and utilized at Seoul National University Hospital Institute and the, 75 Nursing Activities List which was developed´. by the author were utilized in this study. Inter rator reliability was supported for ´both measurement systems.
The general characteristics of patients were classified according to K-DRGs and the 10 most prevalent characteristics were selected and utilized in the _study.
The provided nursing activities in fhe units were observed at 5 minute intervals continuously. The trained investigators and observers classified the patients based-on K-DRGs and measured the time required for nursing activities.
The Seoul National University Hospital guideline of the calculation for medical cost was adopted for the estimation of medical costs and nursing costs. As the first step to determine the prime nursing cost, the elements, items and criterion of medical cost was reviewed, and medical income data was collected from. the receipts of total hospitalization fees for each patient. The items of nursing fee and nursing cost data which was compared to nursing costs and nursing charges were collected from the list of Medical Data Proof of the 62 patients who have records in FSJ National. University Computer Systems.
For this study a system for calculation of nursing cost estimation which was named the Nursing Cost Estimation Process was developed
and applied.
The results of this study were as follows:
1. The total amount of medical cost in each nursing unit during the three months was W29, 084, 702 for nursing unit A, W28, 331, 264 for nursing unit B and W24, 686, 346 for nursing unit C.
2. The average amount of the nursing costs per day in each nursing unit was W9, 943 for nursing unit A, W9, 837 for nursing unit B and W6,139 for nursing unit C.
3. The elements of nursing cost estimated in this study revealed;
1) The proportion of the time required for each of the 75 classified nursing activities showed 31. 1 percent for observation and measurement, 17.3 percent for medication, 15.7 percent for recording, 5.4 percent for in-direct communication, 5. 4 percent for observation and 7. 1 percent for material management, and a very small proportion of time, 0. 1-2.9 percent was used for the activities related to oxygen therapy, heat therapy, exercise, preparation for treatment, hygiene and nutrition.
2) Average nursing care hours per patient per day amounted to 4.6 hours.
3) Direct fee estimated for the materials for hour per person was W64.
4) Average labor cost per hour was W2,748.
5) Indirect cost per hour was -WO)8.
4. The average nursing cost per patient per -day estimated by the Nursing Cost Estimation Process was W12,825.
5. The total amount of nursing cost calculated by the Nursing Cost Estimation Process .according to K-DRGs revealed; W227,089 for K-DRG 202-7M (cirrhosis and alcoholic hepatitis), W136,457 for 203-7M (malignancy of h.epatobiliary system of pancreas), W205,884 for 294-IOM (diabetes, age>35) and W294, 690
for 017-1M (nonspecific cerebrovascular disorders w/o cc).
6. The comparison between the average nursing cost of W12,825 calculated by the Nursing Cost Estimation Process and the actual cost of W1,806 which was charged for the nursing services during hospitalization showed only 14.6 percent of . nursing activities and it was currently reflected in the patient´s hospitalization fee.
From the above research results the following, suggestions can be made;
1) The Nursing Cost Estimation Process is a
valuable system to figure out nursing cost.
2) Each nursing unit should be assumed as cost
revenue for nursing activities, and
3) Nursing prime cost should be estimated more accurately and included in the hospitalization fee.
Although generalization of this study result is limited due to a limited study setting, the basic system for `estimation of nursing cost was developed and tested successfully in the study.
Follpw up studies which disclose the variables influencing nursing cost according to nursing classification groups, and replication studies in other hospital settings will further strengthen and support the efficacy of the developed Nursing Cost. Estimation Process.
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