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

点击翻译按钮获取中文摘要

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