Abstract
BackgroundAging in place is the crucial object of long-term care policy worldwide. Approximately 15.6–19.4 % of people aged 15 or above live with a disability, and 15.3 % of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the “profit willing distance” and the “tolerance limited distance”.MethodsThis cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers’ locations to participants’ homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0.ResultsThere were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550–600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600–1650 m in urban areas and 1950–2000 m in rural areas. In rural areas, 33.3 % of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9 % in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation.ConclusionsOur new “profit willing distance” and the “tolerance limited distance” are considered to be clearer and more equitable than other evaluation indices. They have practical application in considering resource distribution issues around the world, and in particular the rural–urban disparities for public resource.
Highlights
Aging in place is the crucial object of long-term care policy worldwide
In Taiwan, there is a national long-term care (LTC) policy, which is the responsibility of the National Health Insurance Administration (NHI) and the National 10-Year Long-term Care Plan
Home nursing care is supplied by NHI, as part of universal medical coverage, with fees covered by insurance
Summary
Aging in place is the crucial object of long-term care policy worldwide. Approximately 15.6–19.4 % of people aged 15 or above live with a disability, and 15.3 % of them have moderate or severe disabilities. In Taiwan, there is a national LTC policy, which is the responsibility of the National Health Insurance Administration (NHI) and the National 10-Year Long-term Care Plan This program began in 2007, and offers services to people over the age of 65 with limitations on daily living, those over 50 with identified disabilities, and aboriginal people over 55. The majority of people under 50 with disabilities who required LTC services meet the qualifications for low-income households and receive limited healthcare services primarily through the NHI system As this 10-year program ends, and due to the aging population and rising healthcare costs, the Taiwanese government plans to implement a social insurance LTC system for the whole population [4]. For people with more severe disabilities, those involving the loss of functioning in self-care, mobility and cognition, the nursing care demand is expected to increase [5, 6]
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