Study On Actual Cost And Standard Cost Of Grading Nursing In Internal Medical Wards And Specialized Wards Of A Grade Ⅲ-A General Hospital

Background: In our country, the current expense standard for different grades of nursing in a hospital has been set up by a national price organization in accordance with the principles from previous planned economic system. The establishment of this standard is not based on real cost and therefore it is not able to reflect the factual value in various types of nursing. In order to offer fundamental information for policymakers to produce realistic expense standard and provide data for managers to arrange scientifically nursing resources, the present study using the method of cost accounting aimed to analyze both actual cost and standard cost for various types of nursing performed in internal medical and specialized wards in a grade III-A class general hospital. Methods: This study has employed methods of literature review, on-spot interview, questionnaire and expert consultation in six wards to classify the number of nursing tasks and to calculate actual and standard nursing time for different patients under a variety of grades of nursing. According to the principle of cost accounting in the hospital, actual and standard nursing costs have been analyzed based on following five categories: manpower cost, the cost for material and depreciation, business fees, administration expenses, and education and research funds. Results and Conclusion: (1). The grading nursing could be defined as 30 nursing tasks in the grade 1, 22 in the grade 2, and 13 in grade 3. (2). In grading nursing, the actual cost was 4.6 times and standard cost 6.1 times higher compared to the current expense standard. Following downregulation of nursing grades, the decline in the cost calculated according to the current expense standard was smaller than that in actual cost and standard cost of nursing. (3). The actual operating time used in nursing was much less than the standard operating time and the difference was 0.60 times. Because of shortage in nursing manpower, the service of grading nursing failed to meet the required standards and the quality for nursing has been therefore impaired. (4). Manpower cost could be most important component in the nursing cost. There were significant differences in overhead cost between these various grades of nursing. Following the downregulation of nursing to a lower grade, both nursing time and the cost for direct manpower decreased accordingly yet the percentage of the indirect cost went up. (5). To compare the cost between similar tasks should be recommended for calculating the cost for individual nursing task in grading nursing, however, the ratio of income should be used for calculating the total expense cost. (6). The nursing cost could vary in amount even for those patients nursed under the same grade in consideration of possibility of the different nature of operation, facilities and consumables applied for different patients.