[A study on resource based relative values for visiting nursing services].

PURPOSE: The purpose of this study was to investigate the resource based relative values of visiting nursing services, and to analyze the relationships between the relative values and the dimensions of nursing service(time, mental effort and physical effort). METHODS: We interviewed nurses at 20 Home-visit nursing care stations (HVNCS) in the Metropolitan area using the resource based relative value questionnaires. We asked nurses about relative values of "Total Work", and also measured relative weight of 3 dimensions of nursing services. Total Work was defined as comprehensive evaluation of nursing services, with careful consideration of intensity as well as duration. With the dependent variable as Total Work and independent variables as the 3 dimensions, multiple regression analyses were carried out. Furthermore we examined the degree of influence on Total Work by service type and individual respondent. To examine the validity of the results, we timed nursing services and compared the measured time with the answered time. RESULTS: The 107 respondents were all female and their average age was 36.6 years old. They had HVNCS experience of 2.2 years and 95.3% nurses had experience of hospital nursing. "Total Work" and 3 dimension scores were standardized using common logarithms. "Total Work" of every service significantly differed among service types. The 3 dimensions explained 54.6% of Total Work in the multiple regression analysis. Service type explained 3.3% of Total Work. Individual respondent explained 16.0% of Total Work. Answered time and measured time were not significantly different with nursing services. CONCLUSIONS: Although Total Work was somewhat influenced by individual respondent, most of variation was explained by 3 dimensions. Thus, it could be concluded that Total Work is an index of nursing resource input. A further investigation about influence of patients' condition on Total Work is necessary in the future.

[The structural analysis of inpatient medical cost of the aged in 81 secondary medical areas of 12 Prefectures in Japan].

In order to understand the structure of the per capita medical care expenditure of inpatients aged 70 years and over, correlational and principal component analyses were performed using several medical cost indices for fiscal 1991 in 81 secondary medical areas of 12 prefectures. Requests were sent to all of 777 municipalities in the 12 prefectures, and there were 763 responses for the response rate of 98.2%. A total of 1,647,187 residents who had been inpatients based on receipts for inpatient medical care expenditure were surveyed. There were 389,456 who responded that they had been inpatients at least once in the preceding 12 months, in 1991. The main results were as follows: 1) Of the residents aged 70 and over, 32.0% of men and 29.7% of women surveyed had at least one episode of hospital admission in the preceding 12 months in 1991. 2) Large differences in the medical care expenditure per inpatient per year for those aged 70 years and over exist in the secondary medical areas in 12 prefectures. 3) In both sexes, per capita expenditures for inpatient care per year are positively correlated with the bed-days in hospitals per inpatient per year, the bed days per receipt, the medical care expenditure per receipt, and the number of receipts per inpatient per year. On the other hand, for women it is negatively correlated with per capita medical care expenditure per day, but it is not statistically significant. 4) The medical care expenditure per inpatient per day is significantly negatively correlated with bed-days in hospital per receipt, the number of receipts per inpatient per year, bed-days in hospital per inpatient per year for both sexes. On the other hand, it is significantly positively correlated with medical care expenditure per receipt for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Personnel requirements for health examination for 6 month and 9 mont-old children in municipalities in Japan].

Based on the Maternal and Child Health Law, municipalities offer health education, health counseling, health examination, and home visitation service for children and their mothers. In order to determine the personnel staffing requirements for the health examinations of 6 and 9 month-old children conducted independently by municipalities in Japan in 1989, data from the questionnaire survey executed by the Ministry of Health and Welfare in 1990 was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for a response rate of 97.9% Results showed that in 1989, 27.5% of the 3,198 municipalities were able to perform health examinations for 6 month-old children and 24.7% for 9 month-old children. In the case of those cities which had populations over 10,000 but under 20,000, about 30% were able to perform the health examinations for 6 and 9 month-old children independently. In those cities which had health Centers, the health personnel system most adequately supported these health examinations. Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, about 42-45% of the total volume of the work required to be performed by public health nurses during the health examinations for 6 and 9 month-old children had to be covered by assistance from prefectural public health nurses.

[Differences in inpatient medical costs for the aged within one prefecture].

The rapid increase in the proportion of the elderly population has made the problem of medical costs increasingly important. This problem, however, is not uniform over all regions in Japan. In order to determine what factors are associated with per capita medical care expenditure of inpatients aged 70 years and over, in fiscal 1991, correlation analyses were performed using several indices of medical services, socioeconomic factors and medical supplies among 208 municipalities in one prefecture. Data from a survey in 1992 conducted by the Ministry of Health and Welfare was used in the analysis. Requests were sent to all 218 municipalities in one prefecture, and 208 responses were received a response rate of 95.4%. The main findings were as follows: 1) There were large differences in per capita medical care expenditure for those aged 70 years and over among the secondary medical areas in the prefecture. 2) Both the inpatient expenditures per person per year and bed-days in hospitals per person per year were positively correlated with number of hospital beds per 1,000, the aging population rate and death rate of those aged 70 years and over; but correlated negatively with the primary industry population rate for both sexes. 3) Inpatient expenditure per person per day was negatively correlated with the aging population rate, especially for men. 4) Three major factors that correlated significantly and positively with per capita medical care expenditure for those aged 70 years and over were bed days of inpatients per receipt, the total receipts per inpatient per year, and the number of the admission days of inpatients per year. These three major factors were negatively correlated but not significantly, with the per capita medical care expenditure per day. 5) Multiple regression analyses indicate that the aging population rate, the number of hospital beds per 1,000 of those aged 70 years and over, and death rate of those aged 70 years and over were independently correlated with the inpatient expenditure per person per year for both sexes. 6) Results of this analysis indicate that data from secondary medical regions within the prefecture rather than the municipalities yield a stronger possibility of clarifying those factors contributing to differences in per capita medical care expenditure.

[Personnel requirements for health examination of infants under 5 months in municipalities in Japan].

Municipalities offer health education, health counseling, health examinations, and home visitation service for infants and their mothers. In order to determine what the personnel staffing requirements were for health examination of infants under 5 months for municipalities in Japan in 1989, a questionnaire survey was conducted in 1990. Questionnaires were sent to all municipalities and 3,198 responses were received for a response rate of 97.9%. Responses from 912 municipalities were considered invalid, leaving a total of 2,286 responses that were analysed. Results showed that 79.2% of the 2,286 municipalities were able to perform health examinations for infants under 5 months independently, while in 6.5% of the municipalities these examinations were performed by the clinical hospitals. Analysis by size of municipalities showed that 85.7% of the cities with populations of 500,000 or more were able to perform health examinations independently. In the large cities designated by the Government, the health personnel system adequately supported these health examinations. However in rural towns and villages with small populations, it was necessary for public health nurses to be assisted by other staff, most of whom were public health nurses from prefectural health centers. For example, in areas with populations of less than 3,000, about 60% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance from prefectural public health nurses.

The influence of system factors upon the macro-economic efficiency of health care: implications for the health policies of developing and developed countries.

This paper aims to clarify the global association of system factors with the attainment of health policy goals, through economic analyses of cross-country data. In the case of OECD (the Organization for Economic Co-operation and Development) data for 1990, the variation in total expenditure on health among 24 countries can be explained by various factors including Gross Domestic Product (GDP). Among these, the variables representing the level of public sector involvement through social protection or public-private mix within a health care system, such as the Public-to-Total Expenditure Ratio, Coverage Rate and Public Cost Sharing, are significantly negative when factors such as GDP are controlled. This suggests that countries attaining higher equity or accessibility are in a better position to gain higher cost-containment or macro-economic efficiency. The results of this study may be helpful for developing countries searching for a long-term health care system as well as for developed countries facing health care system reforms.

[Evaluation of methods for measuring daily physical activity in terms of energy expenditure].

Various methods exist for measuring daily physical activity and daily energy expenditure and daily pedometer readings are most commonly used for the amount of physical activity. In this study, three methods for measuring energy expenditure-24-hr heart rate method (HR), time study method, and caloric expenditure accumulator (CC)-, and the feasibility of a pedometer for the assessment of energy expenditure were examined under laboratory conditions and during normal daily life. Daily physical activity was measured by four methods (HR, Time study, CC, Pedometer) in a field study of 14 young, healthy and sedentary women, and compared. Laboratory validation of the three methods with measurement of oxygen uptake was performed with 5 young men and 1 woman walking and running at different speeds and grades on a treadmill. In addition validation tests of whether pedometer readings reflect differences in energy expenditure due to speed and grade and whether pedometer counts steps exactly were also conducted. The 24-hr energy expenditure derived from CC was significantly lower than that derived from HR and Time study, due to lower estimation of energy expenditure from activities compared to other methods. In the laboratory study, the energy expenditure measured at 5% grade was low by CC and differences in energy expenditure for changes in grade could not be differentiated. Time study revealed a significant relationship between CC and HR in field study. These results suggest that CC tends to underestimate the 24-hr energy expenditure from activity.(ABSTRACT TRUNCATED AT 250 WORDS)