상대가치 개편에 따른 간호관리료 차등제 등급과 수익금 변화: 일반병동
Changes in Nurse Staffing Grades and Nursing Fee Revenues in Response to the Amendment of the Resource-Based Relative Value Scale: General Wards
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참고문헌
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초록
연구목적: 본 연구의 목적은 3차 상대가치 개편에 따라 2024년 1월부터 적용되고 있는 간호관리료 차등제 등급과 수익금 변화를 분석하는 것이다. 연구방법: 개편된 등급은 일반병동 일평균 환자수를 간호사수로 나눈 값인 간호사 1인당 환자수(patients per nurse, PpN)로 산정된다. 44개 상급종합병원과 328개 종합병원, 1,378개 병원을 대상으로 2023년 4분기에서 2024년 1분기로의 등급과 수익금 변화를 분석하였다. 연구결과: 2023년에 최고등급이었던 1등급은 2024년에 2∼3개 등급으로 세분화되어, 상급종합병원과 종합병원의 최고등급은 S등급(PpN<1.5), 병원의 최고등급은 A등급(PpN<2.0)으로 변경되었다. 최고등급은 상급종합병원에서 72.4%, 종합병원에서 11.8%, 병원에서 22.5%를 차지하였다. 2023년 1등급에서 2024년 S등급으로 변경된 기관에서 발생한 간호사 1인당 연간 간호관리료 추가 수익금은 상급종합병원 1,088,455∼11,412,655원, 종합병원 11,483,834원으로 추정되었다. 결론: 간호관리료는 등급별 필요간호사수에 비례하여 차등화하고, 증가한 간호관리료 수익금은 간호사 보상에 사용해야 한다.
Abstract
Purpose: This study aimed to examine changes in nurse staffing grades and nursing fee revenues following the third amendment of the resource-based relative value scale, implemented in January 2024. Methods: Revised nurse staffing grades were determined based on the number of patients per nurse (PpN), calculated by dividing the daily patient census by the number of registered nurses working in general wards. Changes in staffing grades were analyzed from the fourth quarter of 2023 to the first quarter of 2024 among 44 tertiary hospitals, 328 general hospitals, and 1,378 non-general hospitals. Results: In 2024, the previous "best grade" (grade 1) was subdivided into two or three grades. The best grade was redefined as grade S (PpN<1.5) in tertiary and general hospitals and grade A (PpN<2.0) in non-general hospitals. By 2024, 72.4%, 11.8%, and 22.5% of tertiary, general, and non-general hospitals, respectively, achieved the best grade. The estimated additional annual nursing fee revenues per nurse in 2024 (compared to 2023) for hospitals advancing from grade 1 to grade S ranged from 1,088,455 to 11,412,655 KRW in tertiary hospitals and 11,483,834 KRW in general hospitals. Conclusion: To ensure appropriate nurse staffing levels, nursing fees should be proportionally differentiated based on staffing requirements. Additional revenues should be strategically allocated to enhance nurse compensation, thereby improving workforce sustainability and care quality.
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