입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화 = Changes in Hospital Nurse Staffing after Implementing Differentiated Inpatient Nursing Fees by Staffing Grades

다국어 초록 (Multilingual Abstract)

Purpose: To examine the changes in nurse staffing in hospitals after implementing the policy of differentiating inpatient nursing fees by staffing grades. Method: The study sample included 43 tertiary hospitals, 185 general hospitals, and 282 non-general hospitals that were operating in both 1999 and 2008. Nurse staffing grade was categorized from Grade 1 (highest) to 6 (lowest) in 1999 or Grade 7 in 2008, based on the nurse-to-bed ratio. Results: Tertiary hospitals at Grade 3 and Grade 4 accounted for 49% and 35%, respectively, in 2008, whereas 63% were Grade 6 in 1999. General hospitals at Grade 6 decreased from 87% to 48%. In non-general hospitals, little change was found in the staffing distribution, in that 92% still remained in Grade 6 or 7 in 2008. Forty tertiary hospitals (93%) and 45% of general hospitals improved their staffing grades, while only 7% of non-general hospitals did. Greater likelihood of improvement in staffing grades was found in general hospitals located in metropolitan areas or having 250 or more beds. Conclusion: Elaboration of the financial incentive system is needed to increase the policy impact on staffing improvement.

참고문헌 (Reference)

1 일본 노동후생성, "평성18년 진료보수 개정의 개요"

2 오동일, "의료기관종별 입원료 원가분석 및 적정수준에 관한 연구" 상명대학교 산업과학연구소 2006

3 건강보험심사평가원, "의료기관종별 구분개선에 따른 의료기관종별 인정평가기준개발" 건강보험심사평가원 2006

4 김윤미, "의료기관과 시장특성이 간호사 확보수준에 미치는 영향" 한국보건행정학회 17 (17): 68-90, 2007

5 유선주, "의료기관 종별 간호인력 활용방안에 관한 연구" 한국보건산업진흥원 2005

6 건강보험심사평가원, "상대가치점수 연구 진행경과보고(회의자료)"

7 보건복지부, "복지부, ’05년 의료기관 평가결과 발표(보도자료)"

8 보건복지부, "복지부, ‘06년 의료기관평가결과 발표(보도자료)"

9 보건복지부, "보건복지부 고시 제2008-9호"

10 보건복지부, "보건복지부 고시 제2006-106호"

11 보건복지부, "보건복지부 고시 제2006-105호"

12 국민건강보험공단, "민원업무안내: 보험급여"

13 보건복지부, "공공의료기관 현황"

14 보건복지부, "건강보험요양급여비용"

15 박정호, "간호관리료 수가체계 개선방안 연구" 병원간호사회 2007

16 Rogers, A. E., "The working hours of hospital staff nurses and patient safety" 23 (23): 202-212, 2004

17 Cho, S. H., "The effects of nurse staffing on adverse events, morbidity, mortality and medical costs" 52 : 71-79, 2003

18 Organisation for Economic Co-operation and Development, "OECD Health Data 2007 - Frequently Requested Data set via OECD.Stat"

19 Aiken, L. H., "Nurses' reports on hospital care in five countries" 20 (20): 43-53, 2001

20 Needleman, J., "Nurse-staffing levels and the quality of care in hospitals" 346 : 1715-1722, 2002

21 Person, S. D., "Nurse staffing and mortality for Medicare patients with acute myocardial infarction" 42 : 4-12, 2004

22 Lankshear, A. J, "Nurse staffing and healthcare outcomes: A systematic review of the international research evidence" 28 : 163-174, 2005

23 Coffman, J. M., "Minimum nurse-to-patient ratios in acute care hospitals in California" 21 (21): 53-64, 2002

24 Mark, B. A., "Market, hospital, and nursing unit characteristics as predictors of nursing unit skill-mix: A contextual analysis" 30 : 552-560, 2000

25 Hodge, M. B., "Licensed caregiver characteristics and staffing in California acute care hospital units" 34 : 125-133, 2004

26 Aiken, L. H., "Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction" 288 : 1987-1993, 2002

27 Kim, Y. M., "Factors related to nurse staffing levels in tertiary and general hospitals" 35 : 1493-1499, 2005

28 Buchan,J, "A certain ratio? The policy implications of minimum staffing ratios in nursing" 10 : 239-244, 2005

29 국민건강보험공단, "2006 건강보험통계연보" 국민건강보험공단?건강보험심사평가원 2007

30 보건복지부, "2005말 의료기관 현황"