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KMID : 1004620170230020236
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Clinical Nursing Research
2017 Volume.23 No. 2 p.236 ~ p.247
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A Study on the Appropriateness of Health Insurance Fee
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Kim Yun-Mi
Kim Kyung-Sook
Park Mi-Mi
Kim In-Sook
Kim Mi-Young
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Abstract
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Purpose: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system.
Methods: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance.
Results: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis.
Conclusion: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.
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KEYWORD
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Nursing, Fee and Charges, Relative Value Scales, National Health Insurance, Time
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