| Summary: | 碩士 === 高雄醫學院 === 公共衛生學研究所 === 84 === Given the changes in life expectancy, disease patterns, and
medical technology, the development of long-term care
should emphasize the provision of a spectrum in a variety
of settings. In order to efficiently and effectively use the
limited acute care resources and to provide a continuum of
care at home setting, the home care services was included
in the coverage of the National Health Insurance (NHI) since its
implementation on March 1, 1995. The major purpose
of the study is to examine the impact of the NHI on the
use of home health care services.
Based on a cross-sectional study design, the data for analyses
was 563 claim forms derived from 20 home care
facilities located in Kaohsiung-Ping Region which includes
Kaohsiung City, Kaohsiung County, and Pingtung County during the
period of March, 1995 to February, 1996. Sixty-
three home care nurses'' information were obtained
through mail survey from 20 home care facilities. In addition,
the reimbursement data collected from 3 freestanding home
care agencies were also analyzed. Finally, the
formulas used to predict the demand of home care services were
adopted in this study to forecast the demand for home
health services in the study region.
The mean age of the sample was close to 70 years old, ranging
from 1 to 95. A total of 421 clients (74.8% of all cases)
were the elderly aged 65 and older. The most
frequently reported chronic disease was Cerebrovascular (54.3%
of all cases). On average, each case reported 2.47
items of diagnosed chronic diseases. According to the
extent of urbanization and economic prosperity, the areas with
more home care facilities were found to have higher
probabilities of using home care services correspondingly.
One hundred and thirty-eight cases (24.5% of all cases) were
terminated during the study period. More than 80% of all
terminated cases occurred within the first 6 months; most
of them were closed in the second month. The major reason for
termination of using home care services was due to
death (51.4% of all cases), followed by improvements in
health status (22.5%). No statistically significant difference
was found in terms of physical functioning and disease
patterns for the cases among different types of home
care facilities. In accordance with weighted nursing activity
scores, the study cases with poor physical functioning or
higher charges used more nursing care services. As
compared to the clients getting better, the terminated cases due
to death used to received more nursing care services.
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