台南區域全民健保實施前後居家護理資源使用比較

Comparison of Home Nursing Service Utilization in the Tainan Area before and after National Health Insurance Execution

10.6288/TJPH2003-22-04-05

葉莉莉(Li-Li Yeh)；溫敏杰(Miin-Jye Wen)

全民健保 ； 居家護理資源使用 ； National Health Insurance ； use of home nursing service

台灣公共衛生雜誌

22卷4期（2003 / 08 / 01）

287 - 294

繁體中文

目標：比較全民健保實施前後，台南區域居家護理資源之使用狀況。方法：健保前結果依研究者1998發表之文獻為比較依據[20]，健保後以提供台南區域居家護理服務之九家機構消案個案為對象（條件為在健保實施後收案管理，並於88年終止管理個案）。採病歷查閱法，由專任助理至機構填寫所需資料。所得資料鍵入SPSS10.0系統進行百分比同質性檢定，分析健保前後資源使用是否有差異。結果：健保後年齡層偏高，以81歲以上居多，女性略多於男性，診斷於健保前後皆以循環系統為主，惟健保後腫瘤個案比率降低。個案轉介來源由個案家屬自行聯繫居首轉為病房轉介居首。消案原因仍以死亡居首，惟轉入長期機構者比率由4.9%增為18.2%。本區域居家護理需求滿足率由83年之15.1%上升為88年之21.6%。資源使用顯示平均每案管理日數由110.4天增為185.2天，但平均每週家訪次數則由0.57次降為0.44次。結論：健保實施刺激居家護理服務產業，台南區域居家護理需求滿足相對增加，惟城鄉資源分佈仍顯不均；此外，健保規範及長期照護機構之多樣性與可近性增加亦衝擊居家護理資源使用。

Objectives: To compare home nursing service utilization before and after National Health Insurance (NHI) execution in the Tainan Area. Methods: Clients who enrolled after the NHI program and who were discharged in the period of 1999 were selected as the sample. Also, their nursing care record had been reviewed. A total of 449 patient records were collected from nine hospital-based oriented home nursing agencies. Data were coded and analyzed using the Spss10.0 software system. Results: After the NHI program, we saw a change in the clients' age (older), gender (more female), medical diagnosis (still dominated by circulatory system disease, but the rate of neoplasm had decreased), referral source (more from hospital than by client/ family), termination reason (more clients went to long term care facilities), service provided in this area (before NHI=15.1%, after NHI=21.6%), duration of home nursing service (before NHI=110.4 days, after NHI=185.2 days), and frequency of home visits per week (before NHI=0.57, after NHI=0.44). Conclusions: The NHI program stimulates the provision of home nursing services, but those who live in rural areas still receive less resources. Regulations by NHI and the increased number of long term care facilities has impacted on home nursing resource use.

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