Predictors of home health care services for cerebral vascular disease patients in Taiwan.

Abstract

The National Health Insurance in Taiwan has rigid regulations for reimbursing home nursing care with payment only for technical/skill care such as changing nasogastric tubes, urine catheters, and tracheal tubes, wound care, and specimen collection. Patients with chronic illnesses who reside at home, however, require care that is holistic and focuses on wellness rather than illness. Cerebral vascular disease (CVD) patients are the largest group receiving home nursing care. They qualify for reimbursement under NHI. The purposes of this study were to quantify the home health care (HHC) needs of CVD patients and to understand predictors for HHC services for CVD patients in Taiwan. A descriptive correlation design was used to examine the relationship between a CVD patient's health status and the need for HHC services. In total, 195 patients were interviewed by one trained research assistant, with 124 patients being from Taipei (an urban area in Taiwan) and the remaining 71 from I-lan (a rural area in Taiwan). The mean age of subjects was 74.8 years, with 60% of the sample being female. Physiological health status scores (M = 2.56, SD = 0.58, range = 1-5) were worse than the psychosocial health status scores (M = 2.37, SD = 0.91, range = 1-5), which indicates that the need for health education and skilled nursing services was higher than referral services for professional HHC services. Results suggest that there is a need to develop and shape NHI policy to cover more holistic HHC services for CVD patients.