Abstract
Background: In response to the rapidly aging population with anticipated growth of chronic disabling diseases, the National Health Insurance program in Taiwan has established home health care services since 1995. Medically and functionally compromised elders with multiple chronic conditions, tend to have increased need for home health care (HHC) and higher medical costs. Our study aimed to identify health expenditure and its influencing factors among home care patients and to clarify whether regular HHC visits reduce health expenditure.Methods: A retrospective observational cohort study on individuals receiving HHC was conducted at National Taiwan University Hospital Bei-Hu Branch from 2010 to 2015. Patients aged < 20 years, did not receive HHC for at least 6 months, or did not receive regular hospital care at our healthcare system were excluded. The patient characteristics, health service utilization, and health expenditure were collected. Total health expenditure was defined as the sum of outpatient clinic, emergency department and hospitalization cost. Considering the distribution of costs data was highly skewed, a generalized linear model was applied to estimate the impact patient factors on healthcare expenditure.Results: A total of 1,285 home care patients, mean age 79.4±12.9 years and males 50.9%, were enrolled. The majority (85%) of the study population were totally dependent in daily activities with Barthel index 0-20, and had Charlson comorbidity index score≥4. The median monthly total expenditure per person was US$737 (IQR, 229-1,935), which broke down to US$414 (IQR,56-1,234) for hospitalization, US$170 (IQR,73-369) for outpatient clinic, and US$60 (IQR, 9-150) for emergency department. Home care patients with higher need for nursing services utilization (p<0.05), indwelling tracheostomy tube (p<0.05), underlying neoplasm (p<0.05), or registry of catastrophic illness certificate (p<0.001), had higher health expenditure. On the other hand, regular HHC visits significantly lowered total health expenditure (p<0.001).Conclusions: Patient characteristics that incurred higher health expenditure were identified, whereas regular HHC visits have a potential role to reduce expenditure in the disabled homebound population. The visit number and frequency of HHC should be taken into account when making reimbursement policy in order to provide a sustainable and cost-effective HHC program.
Stakeholders’ Tolerance-based Linear Model for Home Health Care Coordination
