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Nurse–Patient Ratio and NHI Payment Improvement Schemes

  Item 8 of the medical policy proposed by President Tsai in the 2016 Presidential Election mandates that the amount of NHI fees insured pay shall be equivalent to the level of nursing care quality the insured receive to improve nurses' labor conditions and ultimately ensure that nurses receive the reasonable pay they are entitled to. Hospital managers shall be encouraged to value the importance of nurses so that more nursing personnel are motivated to remain or return to their line of work, thereby ensuring patient safety and care quality. Today for the first time, the National Health Insurance Administration (NHIA) opened public access to records of daily average nurse–patient ratios (NPRs) so as to implement the increase of NHI fees according to nurse–patient ratios by: (1) Allocating more budgets to hospitals with higher NPRs; (2) tracking the real-time statuses of nursing personnel human resources in various hospitals; and (3) including NPR-related rules in related regulations. By doing so, the government responds to issues that are of high concern to the general public and society.

  According to NHIA’s statistics regarding the ratio of hospitals reporting their NPRs as eligible for an increase in hospitalization nursing fees, 91% of medical centers, 95% of regional hospitals, and 99% of local hospitals have filed such report in the total reporting period (12 months). The NHIA allocated a total funding of NT$9.165 billion to hospitals for promoting the NHI Enhancement of Hospitalization Nursing Care Quality Scheme, which aims to encourage hospitals to hire more nurses and increase nurses' intention to stay by improving incentive measures such as increasing nurses' wage, night shift wage, overtime pay, and bonuses. Subsequently, the care quality afforded to inpatients can be enhanced. Since the implementation of this policy, the mentioned goal has been achieved. Statistics reveal that the period of 2010–2015 registered a net increase of 8,945 nurses. Particularly, over a period of six years, medical centers accumulated an increase of 3,623 nurses, whereas regional hospitals and local hospitals projected an increase of 4,636 and 690 nurses, respectively. Although the policy demonstrated preliminary effectiveness, it still has room for improvement.

  To ensure that the payment standard adjustment is in line with the labor conditions of nursing staff and that this system can be internalized in hospital management, the National Health Insurance Committee agreed to transfer NT$2 billion of the fund used for enhancing hospitalization nursing care quality to general service departments. Thus, the total amount of this fund can increase with the growth rate of general departments. Furthermore, NPR requirements shall be specified in payment standards and the new payment policy, and hospitals shall be required to submit their NPR information on a monthly basis and increase hospitalization nursing fee by 9% to 11% in accordance with the recorded NPRs.

  The NHIA shall, as of today, issue quarterly announcement regarding hospitals' NPR information to facilitate public monitoring and strengthen information transparency. To ensure that insurance premiums are fair and reasonable, relevant divisions under the Ministry of Health and Welfare shall strengthen the monitoring of nursing staff conditions in all hospitals, designate NHIA representatives to conduct onsite inspections, and simultaneously encourage the public and nursing teams to collectively participate in monitoring tasks. The equation for increasing NPRs shall be improved continuously to calculate NPRs according to ward type (e.g., ICUs or pediatric wards) or different time period (e.g., three work shifts per day), and allocate more budget to hospitals with higher NPRs. We expect to work with hospital managers in jointly improving problems concerning shortage of nursing staff and effectively prevent job burnout among nurses. The aforementioned payment standard adjustment shall be negotiated in accordance with law and the standards shall be adjusted according to the outcome of the negotiation. As of August 1, the NHIA anticipates investigating the Effect of Hospital Payment Standard Adjustment on the Salary of Health Care Professionals to elucidate how such adjustment influences nurses' salaries and whether it meets public expectations.

  The NHIA would like to express its gratitude to all nursing staff members for their devotions and efforts in patient care. The NHIA will continue negotiating and communicating with relevant communities in the future to maintain patient care quality and protect the rights and interests of workers in the health and medical industry.

  • Date:2016-07-20