Di Nitto Marco, Napolitano Francesca, Calzolari Michela, Longobucco Yari, Masotta Vittorio, Zaghini Francesco, Alvaro Rosaria, Cicolini Giancarlo, Lancia Loreto, Manara Duilio Fiorenzo, Rasero Laura, Rocco Gennaro, Zega Maurizio, Mazzoleni Beatrice, Sasso Loredana, Bagnasco Annamaria
Department of Health Sciences, University of Genoa, Via A. Pastore 1, Genoa, 16132, Italy.
Ospedale Policlinico San Martino, DEA, Largo Rosanna Benzi, 10, Genoa, 16132, Italy.
BMC Health Serv Res. 2025 Jan 17;25(1):95. doi: 10.1186/s12913-024-12116-3.
The rising cost of healthcare is a concerning issue for healthcare systems. The Diagnosis Related Group (DRG) system lacks direct consideration for costs related to nursing care. Therefore, to date there is no clear picture of billing models that consider also nursing activity when evaluating healthcare service costs or what factors related to nursing care affect the costs of healthcare services and would therefore need to be considered in billing models.
A scoping review was conducted. We searched articles published from January 2000 to September 2023, in English, Italian and Spanish. We consulted MEDLINE (Pubmed), CINAHL (EBSCOhost), Web of Science (Clarivate), SCOPUS (Elsevier), ProQuest and Google Scholar, government sites and major international bodies (e.g., National Health Service NHS, World Health Organization WHO).
We included a total of 31 studies. The results highlighted 3 categories of factors related to nursing costs, which involve the organisation (e.g., nurse-to-patient ratio), nurses (e.g., skill mix, interventions), and patients (e.g., patient complexity, patient outcomes). All the billing models reported in the literature considered one or more of these categories to estimate nursing costs. The results also showed that appropriate management of organisational and nursing factors, such as staffing and skill mix, could improve healthcare service costs, nursing care or practice, and patient outcomes.
This study sheds light on the multifaceted aspects of nursing care that should be considered in a specific, comprehensive, billing model. Additional testing of existing models to verify their effectiveness, as well as the organisation of a permanent committee (or Task Force) that develops a comprehensive billing model, are necessary to guide the formulation of new policies.
医疗保健成本的不断上升是医疗系统面临的一个令人担忧的问题。诊断相关分组（DRG）系统没有直接考虑与护理相关的成本。因此，迄今为止，在评估医疗服务成本时，对于考虑护理活动的计费模式尚无清晰的认识，或者不清楚与护理相关的哪些因素会影响医疗服务成本，因此在计费模式中需要考虑这些因素。
进行了一项范围综述。我们检索了2000年1月至2023年9月以英文、意大利文和西班牙文发表的文章。我们查阅了MEDLINE（PubMed）、CINAHL（EBSCOhost）、科学网（Clarivate）、Scopus（Elsevier）、ProQuest和谷歌学术、政府网站以及主要国际机构（如英国国家医疗服务体系NHS、世界卫生组织WHO）。
我们共纳入了31项研究。结果突出了与护理成本相关的3类因素，涉及组织（如护士与患者的比例）、护士（如技能组合、干预措施）和患者（如患者复杂性、患者结局）。文献中报道的所有计费模式都考虑了这些类别中的一个或多个来估算护理成本。结果还表明，对组织和护理因素（如人员配备和技能组合）进行适当管理，可以改善医疗服务成本、护理服务或实践以及患者结局。
本研究揭示了在特定、全面的计费模式中应考虑的护理多方面问题。有必要对现有模式进行额外测试以验证其有效性，以及组建一个制定全面计费模式的常设委员会（或特别工作组），以指导新政策的制定。
