국민건강보험 간호·간병통합서비스의 전면 도입을 위한 간호인력 및 재정비용 추계 Optimal Nursing Workforce and Financial Cost to Provide Comprehensive Nursing Service in the National Health Insurance System원문보기
본 논문은 병원에서 간호 간병통합서비스가 전국에 확대 적용되었을 경우 필요한 간호인력과 재정비용을 추계한 연구이다. 연구자료는 건강보험심사평가원으로부터 받은 2012년 기준 간호사 수, 간호조무사 수, 의료기관 수, 환자 수를 이용하였다. 간호 인력의 규모는 결정론적 방법으로 개발된 작업부하모델에 의해 추정되었다. 간호간병통합서비스 연간 총 재정비용을 계산하는데 상향식 추정방법이 사용되었다. 간호사 및 간호조무사 수는 각각 81.8%, 83.2% 더 증가되어야 간호 간병통합서비스가 전국 규모로 적용가능한 것으로 추정되었다. 전국의 모든 일반병동에 간호 간병통합서비스가 적용되기 위해 필요한 재정적 비용은 110.4% 더 증가해야 할 것으로 추정되었다. 이 새로운 시스템을 성공적으로 구현하려면, 인력공급의 양적확대 전략뿐만 아니라 숙련된 간호사와 신규간호사의 이직을 최소화해야 한다. 또한 간호사-환자 비의 타당성을 지속적으로 확인할 필요가 있다. 새로운 시스템을 모든 병원에 단계적으로 확대하여야 국민건강보험의 재정부담을 최소화할 수 있을 것이다.
본 논문은 병원에서 간호 간병통합서비스가 전국에 확대 적용되었을 경우 필요한 간호인력과 재정비용을 추계한 연구이다. 연구자료는 건강보험심사평가원으로부터 받은 2012년 기준 간호사 수, 간호조무사 수, 의료기관 수, 환자 수를 이용하였다. 간호 인력의 규모는 결정론적 방법으로 개발된 작업부하모델에 의해 추정되었다. 간호간병통합서비스 연간 총 재정비용을 계산하는데 상향식 추정방법이 사용되었다. 간호사 및 간호조무사 수는 각각 81.8%, 83.2% 더 증가되어야 간호 간병통합서비스가 전국 규모로 적용가능한 것으로 추정되었다. 전국의 모든 일반병동에 간호 간병통합서비스가 적용되기 위해 필요한 재정적 비용은 110.4% 더 증가해야 할 것으로 추정되었다. 이 새로운 시스템을 성공적으로 구현하려면, 인력공급의 양적확대 전략뿐만 아니라 숙련된 간호사와 신규간호사의 이직을 최소화해야 한다. 또한 간호사-환자 비의 타당성을 지속적으로 확인할 필요가 있다. 새로운 시스템을 모든 병원에 단계적으로 확대하여야 국민건강보험의 재정부담을 최소화할 수 있을 것이다.
This study estimated the optimal nursing workforce and financial costs of providing comprehensive nursing services at hospitals under the national health insurance system. Data on registered nurses, nursing aids, medical institutions, and number of patients were obtained from the Health Insurance Re...
This study estimated the optimal nursing workforce and financial costs of providing comprehensive nursing services at hospitals under the national health insurance system. Data on registered nurses, nursing aids, medical institutions, and number of patients were obtained from the Health Insurance Review and Assessment Service. The optimal size of the nursing workforce was calculated using the workload model. A bottom-up approach was used to estimate the annual total financial cost of comprehensive nursing services. The number of registered nurses and nursing aids would need to be increased by 81.75% and 83.23%, respectively, in order to fully apply comprehensive nursing care on a national scale. The additional financial costs for comprehensive nursing services at all hospitals was estimated to be as much as 110.39% of the current cost. For the comprehensive nursing service, nurses with a career and newcomers need to be retained at their hospitals, and the validity of the nurse-patient ratio should be continuously checked. The financial shock to the national health insurance system could be minimized by gradually extending the system to all hospitals.
This study estimated the optimal nursing workforce and financial costs of providing comprehensive nursing services at hospitals under the national health insurance system. Data on registered nurses, nursing aids, medical institutions, and number of patients were obtained from the Health Insurance Review and Assessment Service. The optimal size of the nursing workforce was calculated using the workload model. A bottom-up approach was used to estimate the annual total financial cost of comprehensive nursing services. The number of registered nurses and nursing aids would need to be increased by 81.75% and 83.23%, respectively, in order to fully apply comprehensive nursing care on a national scale. The additional financial costs for comprehensive nursing services at all hospitals was estimated to be as much as 110.39% of the current cost. For the comprehensive nursing service, nurses with a career and newcomers need to be retained at their hospitals, and the validity of the nurse-patient ratio should be continuously checked. The financial shock to the national health insurance system could be minimized by gradually extending the system to all hospitals.
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문제 정의
The study are to estimate the optimal number of RNs and NAs when the comprehensive nursing service becomes extended nationwide and to estimate the annual financial cost of the comprehensive nursing service covered by national health insurance.
KCNS is expanding to hospitals of all over the nation. This study estimated the nursing workforces and annual total hospitalization fees due to induction of comprehensive nursing services in nationwide. It showed that the nursing workforce needed for the system to be successful is 80% more than the current.
This study shows that the new nursing delivery system can increase the burden on the supply and demand of human resources and finance of Health Insurance. It may be necessary to increase the individual out-of-pocket payment for hospitalization fee and to let hospitals with the appropriate infrastructure and workforce establish comprehensive nursing wards.
제안 방법
it is possible to assign the various combination of hospitalization fees depending on scenario to estimate total financial cost [17]. In this study, the economic variables used median hospitalization fees of general hospitals and small hospitals, and upper hospitalization fees of tertiary hospitals. And over the last five years, the number of medical institutions has increased by 1-2% per year and the number of hospitalization days has increased by 3-6.
Those data were announced by Ministry of Health and Welfare in 2015 (Table 2). The data of HIRA included that number of facilities, average number of patients per day, hospitalization fees and nurse staffing levels according to the Graded Nursing Fee Policy (GNFP) (Table 3). The GNFP is the differentiation scheme for hospitalization fees applied since November, 1999 before the KCNS system.
이론/모형
A bottom-up estimation method was used to calculate total financial cost of KCNS. This approach is generally used in most countries to estimate finances.
The size of the required nursing workforce was measured by a workload model developed using a deterministic method. Considerations in determining the number of staff to employ include the hours for which coverage is required, vacations, holidays, and absenteeism [15].
성능/효과
If all tertiary hospitals, general hospitals, and small hospitals implement KCNS in its general wards, additional costs would be estimated to increase by 138.70% for tertiary hospitals, 111.67% for general hospitals, and 94.01% for small hospitals. The total expense of KCNS was estimated to be KRW 6,879.
30% for small hospitals. In total, the increase was calculated as 81.75% for RNs and 83.23% for NAs (Table 4).
The estimated results in case when KCNS is fully applied nationwide are as follows; the number of RNs should increase by 66.14% for tertiary hospitals, 58.33% for general hospitals, and 122.79% for small hospitals. The number of NAs should increase by 111.
후속연구
For example, the number of NAs working in a general ward could be inaccurately ascertained from raw data. Further studies are needed to clarify the cause of the differences of the number of required NAs using original data on accurate securing NAs. And it is necessary to develop an estimation method that can reflect the detailed situation condition more precisely.
More studies using original data on the level of securing clear NAs are necessary. Further studies will be needed to clarify the cause of the large differences of the number of required NAs.
We hope this study could be helpful to prepare nursing labor supply and secure policy and to secure the health insurance fund for professional nursing care service without family or informal caregivers in acute hospitals.
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