Changes in Nursing Grades and Nurse Staffing Levels following the 2024 Revision of Nursing Management Fee Standards: A Focus on Tertiary Hospitals and Medical Institutions in Seoul

Background:The inpatient nursing management fee differentiation system adjusts inpatient fees based on nurse staffing levels.In January 2024, the policy was revised, and the grading criteria for tertiary hospitals and medical institutions in Seoul were changed from "beds-to-nurses" to "patients-to-nurses. " This study therefore aimed to analyze changes in grade distribution and nurse staffing levels following the policy revision, focusing on these institutions.Methods: "Healthcare institution status reports, " "Inpatient nursing management fee differentiation assessment records, " and "National Health Insurance claim data" from the fourth quarter of 2023 to the second quarter of 2024 were analyzed.The study assessed the distribution of healthcare institutions according to nursing grade and changes in nurse staffing levels using descriptive statistics and ANOVA.Nurse staffing levels were calculated as the "beds-to-nurses" ratio.Results: After the revision, nursing grades improved across all medical institutions.All tertiary hospitals were classified as either grade S or A, with a "patients-to-nurses" ratio below 2.0:1.In general hospitals, 39.5% and 18.6% were classified as grade A and S, respectively.For hospital-level institutions, the proportion in the top two grades increased significantly from 14.7% to 46.0%.Despite the shift in grading criteria, the average number of nurses in tertiary hospitals and Seoul institutions decreased in 2024.As such, no significant changes in nurse staffing levels were observed. Conclusion:The 2024 revision of the inpatient nursing grade system improved the compensation for nursing workloads but did not immediately increase nurse staffing levels.Long-term data analysis is needed to assess whether fee adjustments raised staffing levels and enhanced nursing services and inpatient care quality.