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

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.

Financial success under PPS: how to beat the odds.

Whether you are a publicly held company or a small mom and pop agency, you have to maximize both efficiency and productivity while maintaining patient satisfaction and staff morale. In the new world of home care, this is a tall order. In this first installment of a two part series, the author reviews the dimensions of financial success, issues of length of stay and episode of care, resource utilization planning, and reducing overhead. The second part will cover overall productivity, clinical productivity, and management strategies to synergize financial success under the prospective payment system.

How IDSs can turn BBA postacute care provisions to their advantage.

Reductions in payments imposed by the Balanced Budget Act of 1997 may force postacute care providers to impose limits on the number and acuity of patients they can accept. As a result, integrated delivery systems may face reduced access to postacute care. An integrated delivery system's financial well-being may be undermined if its only alternative is to care for postacute care patients in high-cost, acute care settings. To address this problem, IDSs should analyze the financial impact of the Balanced Budget Act and share results throughout their systems, determine how financial incentives affect postacute care utilization, conduct interviews to garner support for strategic objectives, evaluate current operational policies and procedures to determine whether they meet Balanced Budget Act requirements, assess their demand for postacute care services, and develop strategies that fairly distribute the impact of changes among all constituencies.