Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study.

BACKGROUND: In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan. METHODS: We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis. RESULTS: Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS. CONCLUSIONS: Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.

Direct reimbursement of nurse practitioners in health insurance plans of research universities.

The purpose of this study was to explore the nature of health insurance coverage research universities offer their employees and the extent to which these employers offer options providing for reimbursement of services of independent nurse practitioners. A request for health insurance documents mailed to 77 public research universities resulted in a response rate of 83 per cent. A total of 75 per cent sent usable descriptions of insurance coverage for analysis. Among the respondents, 69 per cent (n = 40) reported offering insurance through Blue Cross/Blue Shield companies. Nursing services reimbursed generally included traditional nursing care such as private duty nursing and home health care. Coverage of nursing services that overlap with traditional medical practice, such as prenatal care and labor and delivery services of nurse midwives, anesthesia services of nurse anesthetists, psychiatric services of nurse specialists, and primary care nursing services of nurse practitioners, was less evident. Findings generally indicated that in spite of the presence of enabling or mandatory state legislation for third-party reimbursement of nursing services, legislation is not being implemented in many states by employers in their purchase of group policies.

[Need for and availability of services by nursing insurance for patients with rheumatoid arthritis]. / Bedarf an und Versorgung mit Leistungen aus der Pflegeversicherung bei Patienten mit rheumatoider Arthritis.

UNLABELLED: Although rheumatoid arthritis is amongst those functional disabling diseases requiring massive help and care, there is as yet no study on how RA patients master their everyday lives, nor are there reports on how many of those patients are in need of and/or do in fact receive benefits from the German Nursing Care Insurance. METHODS: In a representative sample of considerably disabled RA patients (functional capacity < 67%) in rheumatological care it was investigated how many patients received nursing care insurance benefits and how many more would have been entitled to receive them. Standardized interviews exploring functional capacity, amount of help and care needed and help-seeking behaviour were conducted to determine which patient-related and resource-related characteristics were associated with unmet need regarding the patients entitlement to benefits of nursing care insurance. Using the relation between justified need for nursing care insurance benefits and the functional status score, a coefficient was computed by logistic regression to project the expected proportion of RA patients entitled to care insurance benefits. RESULTS: A projected 5.4% of all RA patients needed benefits from the nursing care insurance, but only 63% of those did in fact receive benefits. It was found that unmet need was almost exclusively due to the fact that patients actually eligible for insurance benefits did not apply for it, whereas unjustified rejection of applications by insurance experts made up for only a marginal proportion. CONCLUSION: Applying for nursing care insurance benefits is still not a matter of course. It must be considered that about one third of all obviously care-dependent RA patients either claim care insurance benefits too late or never do. To avoid unmet need, experts should encourage particularly those patients who are unaware of their right to ask for help.

[Documentation in expert evaluation of disability status by the medical service of hospital insurance]. / Berichterstattung zur Begutachtung der Pflegebedürftigkeit durch den Medizinischen Dienst der Krankenversicherung (MDK).

A first survey is given by the documentation of the examination for the statutory nursing care insurance. The first part of the report contains the complete tabulated results of the Federal Republic of Germany. Furthermore a graphical comparison of elected federal states has been statistically evaluated and is commented upon.