주요 간호활동의 건강보험 수가 적절성에 관한 연구
A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices
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참고문헌
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초록
연구목적: 본 연구는 현행 건강보험 간호수가제도의 문제점과 개선방안을 제시하기 위한 것이다. 연구방법: 간호사가 주로 수행하는 23개 간호행위를 선정하고 건강보험심사평가원의 상대가치 점수와 기준을 조사하였다 60명의 임상간호패널을 구성하고 패널에 의한 자가보고방식의 간호시간을 조사하였고, 간호시간과 상대가치점수, 실제 인건비로 실질 간호수가를 계산하였다. 최종적으로 실질간호수가와 건강보험수가와 비교하였다. 연구결과: 현행 건강보험수가에는 간호사가 주로 수행하는 행위임에도 타직종이 주시술자로 되어 있으며 간호행위 투입시간이 일부 부적절하게 반영되어 있다. 즉, 간호사가 주로 수행하는 당검사(반정량)는 임상병리사가 주수행자로 기술되어 있다. 연구에서 산출한 간호사 인건비와 건강보험 수가의 인건비 격차가 9.3배(중위수 기준)-11.9배(평균값 기준)인 것으로 나타났다. 결론: 본 연구를 통하여 건강보험의 행위별 진료비지불제도가 타당성과 합리성을 보강하고, 실제 간호시간을 반영한 간호수가 개선을 통해 임상간호의 질을 향상할 수 있는 정책이 필요한 것으로 사료된다.
Abstract
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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