| Background:According to the spirit of some related documents and the status of health care, the government constructed the comparatively perfect health care system recently in Shandong. The current studies on nursing healthcares were mainly about the nursing staff allocation and management, the clinic nursing service, the quality of nursing healthcare, the satisfaction of patients, the supporting system and the service model, but little about the charging. Now the health institutions in Shandong executed the document named The Charging Items and Standard in Shandong which was made jointly by The Bureau of Price, The Department of Finance and The Department of Health of Shandong province in August of 2000. This document included 2,165 charging items, of which the number of nursing items was 54(2.5%), and it was much less than the 486 items in the nursing intervention classify (NIC). Because of absence of many nursing items, this charging mode was unreasonable, which would hinder the development of the nursing. Therefore, to define the nursing charge items coincide with the requirement of the development of the nursing. Besides, it will provide some references for implementing the primary health care system and improving the utilization efficiency of health resources.Objectives:Based on investigating the current charging for nursing and the charging items, the paper analyzed the problems of the nursing charge and presented some strategies in order to provide evidence for constructing the system of accounting and management on nursing and forming the charging mode of nursing suitable to China.Methods:Stratified random sampling was conducted, and 10 hospitals from triple 3 hospitals, 12 hospitals from triple 2 hospitals and 5 hospitals of triple 1 were investigated in Shandong. The expert consulting method was used to investigate the nursing care contents, the nursing items, the charging price and the existing problems in Shandong Province.Results:1. There were 87 nursing care items in Shandong Province, which made up 17.2% of Nursing Intervention Classify (NIC), but only 46 of these nursing items were allowed to charge fee .2. 50 nursing items were stated as the conventional nursing care by the Bureau of health of Shandong Province, and only 18 items (36%) were allowed to charge fee, which meant the nurses had to pay more attention to these nursing items without any revenue.3. In the Fee Standard of Medical Cares of Shandong Province, 26 nursing cares were involved but 22 of them, the fee level were much lower compared to the National Fee Standard of Medical Cares.4. The nursing cares were grouped into 6 categories according to the situation of medial organizations in Shandong Province, the nursing cares should be provide aimed to satisfied the basic physiological needs, overall physiological needs, behavioral nursing needs, safety nursing needs, family nursing needs and health nursing needs.5. According to its needs, the nursing care items were divided into 3 categories: health care items which should be provided, which can be provided and which should be provided specially; accordingly, the charge items of nursing care were divided into: (1) service items which were carried out generally at present and had been charged; (2) service items which were carried out generally but not charged; (3) service items which should be charged according to the clinical practice; (4) service items which should be charged after the actual clinical situation.6. Based on this and combined with the country's policy, the current service situation carried by health care sectors, the residents' health situation and the needs to the community prevention and protection, the key contents of the nursing items were determined initially.
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