Abstract
BackgroundHome healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan.MethodsPatients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored.ResultsAmong 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9%) patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%). More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%).ConclusionsNine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.
Highlights
Home healthcare services are important in aging societies worldwide
Special skilled nursing services include the changing of urinary catheters or nasogastric tubes, or tube tracheostomy, nephrostomy or cystostomy catheters; changing the dressing of stage III and IV pressure sores; intravenous fluid injection and ostomy nursing [7]
The NHI reimburses home nursing visits with fixed rates according to resource utilization groups (RUGs) graded 1-4 as follows: RUG-1 are patients who need general nursing care services only; RUG-2 patients need a single additional kind of special skilled nursing care service besides general nursing care; RUG-3 patients need two additional kinds of special skilled nursing care services; and RUG-4 patients need an additional three kinds of special nursing care service [7]
Summary
Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan. Population ageing with an increasingly disabled population has become a major concern in developed and developing countries [1,2], and the demand for longterm care services is rising [1,2,3]. The impact of rapid population ageing is complex and raises many healthcare issues including the long-term care of disabled people in countries including Taiwan [5]. The home healthcare services items reimbursed by NHI in Taiwan include general nursing services, special skilled nursing services, laboratory tests, nurse visits and physician visits [7]. The general nursing care services include physical evaluations, nursing instructions, drug injections and fecal extraction. The NHI reimburses physician visits in a fixed payment, not according to the RUG classification of patients as for nursing visits [7]
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