Rodolfo C. Borromeo, RN, Ed.D., Annabelle R. Borromeo, RN, Ph.D.
Maria Linda G. Buhat, RN, Ed.D. Andre Lew D. Collado, RN
Association of Nursing Service Administrators of the Philippines, Inc.
Republic Act 7875 or the National Insurance Act of 1995, Article 2, Section 4 defined the term “Fee-for-service payments of health care providers” as “a reasonable and equitable health care payment system under which physicians and other health care providers receive a payment that does not exceed their billed charge for each unit of service provided.” However, among the health care providers mentioned in that law and for past years that it came into effect, it is only the physicians, dentists and midwives who reimburse fee for their services rendered to their respective clients. This prompted ANSAP to convene and recommend a study to engage to a constructive and robust disposition to justify its position in the same Fee for Service enjoyed by the aforementioned profession.
In response to this situation, the Association of Nursing Service Administrators of the Philippines (ANSAP, Inc determined the demographic profile of the respondents; the level of complexity and the time spent based on the pre-determined nursing procedures; and formulate practical computation standard for a reimbursement scheme framework and recommend equivalent fee for service termed as “price points”.
The ANSAP Nursing Procedure Costing Assessment Tool, both in print and online electronic surveying system was used in gathering responses in order to identify the mean level of complexity and mean time spent for each of the nursing intervention. For the research framework, the study used the Conical Model of the Costing of Nursing Services in the Philippines, which hypothesized that while the scope of nursing practice widens its level of complexity and the time spent needed to accomplish the procedure increases. The study used a formulation given the mean Level of Complexity (LC) and the mean Time Spent (TS) of each procedure. The sum of the two made up the Relative Value Unit (RVU) for each procedure. The resulting RVU would then be multiplied to a Peso Conversion Factor (PCF) which is dependent on the position of the nurse (Staff Nurse, Head Nurse or Nurse Supervisor). The product between the two would be the Price Point (PP) or the actual price of the nursing intervention.
The research study was able to gather a total of 1,025 respondents nationwide based on the identified hospitals in the study. Among those who participated, majority of respondents came from those who finished their BSN degree. The highest number of respondents came from the staff nurses. Most of the respondents have 2 years of experience. Majority of the respondents came from the National Capital Region. Based on the Level of Complexity, insertion of endotracheal tube ranked highest and interpreted as a “More Complex” procedure. Based on Time Spent, Assisting major operations obtained the highest mean, interpreted under the 41 – 1 hour to accomplish. The top procedure that obtained the highest price point in all 3 nursing positions was assisting in Major Operation. The highest price points obtained in all procedures per position were: staff nurse (₱197.59), head nurse (₱237.11); and nurse supervisor (₱276.63). The study also revealed a strongly positive relationship between the level of complexity and the time spent given per procedure, with a p-value of 0.000, which is significant at 0.01 level.
Key terms: costing, reimbursement, price points, nursing service, ANSAP