A REIMBURSEMENT SYSTEM PROPORTIONATE TO THE AMOUNT OF NURSING CARE AND ASSISTANCE RENDERED FOR LONG-TERM PATIENTS

为了提供最合适的医疗服务，并提供一个合理的补偿制度，我们试图建立一个分类的长期病人，将适当地反映他们的临床条件和需要的照顾和援助的日常生活活动（ADL）。本研究采用问卷调查法，从病人的临床状况和需要、护士和日常生活活动助理对病人负担感的主观评价、病人对护理服务的满意度三个方面对护理服务的满意度进行了评价。3）实际用于护理和协助的时间。受试者包括10个卫生保健机构的891名患者：2个特殊护理院的203名患者; 6个护理院的322名患者; 1个老年医院的268名患者; 1个慢性病医院的98名患者。 关于我们 主观评价的负担感作为目标变量，进行方差分析，根据患者的ADL援助需求产生五个类别。接下来，患者的想法表达被引入作为另一个变量的分析。由此将日常生活能力分为六类，这六类可解释护理人员工作负担感的50%变异。慢性病医院的差异的责任特别低，表明其他因素的参与，在诱导员工的负担感。提供照顾和协助的时间随病人伤残程度的提高而延长。我们目前的分类长期患者的基础上需要照顾和ADL援助似乎是足够可靠的。根据医疗需要对病人进行类似的分类，有助于提供合理的报销制度。少

In order to offer the most suitable health service and provide a reasonable a reimbursement system, we attempted to establish a classification of long-term patients that would appropriately reflect their clinical conditions and needs for care and assistance in daily life activities (ADL). Such a classification should be based on the patients' information such as can be obtained with relative ease during their stay in institutions.In our present investigation, we conducted a survey to evaluate the amounts of nursing care and assistance in terms of three factors : 1) patients' clinical conditions and needs for assistance ; 2) subjective evaluation by nurses and ADL assistants of their sense of burden ; 3) the actual time spent for nursing care and assistance. The subjects consisted of a total of 891 patients in ten health care institutions : 203 patients in two special nursing homes ; 322 in six nursing homes ; 268 in one hospital for the aged ; 98 in one chronic hospital.First, with the … More subjectively evaluated sense of burden as the target variable, a variance analysis was carried out, which yielded five categories according to the patient's needs for ADL assistance. Next, the patient's expression of ideas was introduced as another variabale into the analysis. This led to a classification with six categories for ADL.These categories accounted for 50% of the variance for the sense of burden felt by nursing personnel in their work. The accountability of the variance was particularly low for the chronic hospital, indicating the involvement of other factors in inducing the sense of burden among the staff. The time to provide care and assistance lengthened as the categorized degree of patient's disability advanced. Our present classification of long-term patients based on the need for care and ADL assistance appeared to be sufficiently reliable. A similar classification of patients according to the need for medical care is useful for providing a reasonable reimbursement system. Less