국내 전문간호사의 역할, 업무 및 수가 보상에 대한 현황 조사와 수가 보상 개선 연구
A Study of the Roles, Practice, and Reimbursement of Korean Advanced Practice Nurses, and Proposal for Improving Reimbursement Policies
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목적: 본 연구는 국내 전문간호사의 실무에서의 활용도를 높이기 위해 전문간호사 보상 체계 개선방안을 도출하는 것이다. 방법: 본 연구는 다음과 같은 3단계로 수행되었다. 첫째, 국외 전문간호사 제도 운영 및 수가 실태를 검토하였다. 둘째, 실무에서 활동 중인 분야별 전문간호사를 대상으로 포커스 그룹 인터뷰와 온라인설문조사를 통해 전문간호사의 업무 및 역할, 수가 및 보상에 대한 의견을 조사하였다. 셋째, 이를 토대로 전문가 의견 수렴을 거쳐 전문간호사에 대한 수가 적용 방안을 도출하였다. 자료수집은 2023년 3월부터 6월까지 진행되었다. 결과: 미국에서는, 1997년 제정된 balanced budget Act에 의해 전문간호사들이 제공한 서비스에 대해 의사 수가의 85~100%까지 보상을 받고 있다. 반면, 일본의 경우에는 별도의 교육을 받은 인정간호사가 수행하는 38개 task에 대해서만 환급을 받을 수 있다. 석사 수준의 전문간호사 교육은 만들어졌지만, 국가적으로 법제화는 되어 있지 않다. 포커스 그룹 인터뷰 결과, 전문간호사의 역할과 업무 범위에 대한 인식과 인정이 낮고, 법적 업무 범위가 제한적임을 지적하였다. 온라인 설문조사 결과, 전문직으로서의 자부심은 높으나 보수에 대한 만족도는 상대적으로 낮았으며, 71.4%가 분야 통합이 필요하다고 응답하였다. 또한 전문간호사의 수가 개선 방안으로 현재 특정 분야에서 급여 적용을 받는 수가에 대해 타 분야의 전문간호사에게도 확대하고, 이들의 역할과 보상 체계를 주기적으로 검토할 것을 제안했다. 결론: 본 연구 결과, 전문간호사의 역할과 업무 범위를 명확히 하고, 전문적인 간호행위에 대한 수가와 보상 체계를 마련하는 것이 필요하다. 본 연구는 전문간호사의 수가 개선과 제도 개선 방향을 제시함으로써 전문간호사 제도의 활성화와 보건의료서비스의 질 향상에 기여할 것으로 기대된다.
Abstract
Purpose: This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice. Methods: The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023. Results: In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended. Conclusion: In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.
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