Use of Post-Hospital Care to Disabled Stroke Patients in Taiwan: A National Health Insurance Experience

The study examines factors associated with the utilization of post-hospital care of disabled stroke patients within 6 months after hospital discharge and the varied costs to the national health insurance (NHI) system. A sample of 1,534 disabled stroke individuals 50 and order who were hospitalized in the past year was extracted from a nation-wide random sample. The first hospitalization in that year was designated as their index hospitalization. Six months of NHI claim data together with matched survey results were analyzed. Multiple regression and ANOVA identified factors associated with the use of post-hospital care.

Results: The hospital readmission rate within 6 months after index hospitalization was 46.5%. Utilization of outpatient service was 98.1%, emergency service 38.0%, home nursing service 12.2%, and rehabilitation rate 32.3%. Results revealed that co-payment, long-term care arrangement, living in cities, co-morbidities, functional dependency were significant variables. Patients who are waived of NHI co-payments, cared in institutions, living in municipalities, completely dependent, or have suffered from three and more chronic diseases consume more health care and higher cost to the NHI.

Implication & Conclusion: In allocating NHI resources and policy design, these factors should be taken into consideration for better resource management and efficiency. While an diagnosis related groups system in the NHI being started, issues concerning post-hospital care in terms of insurance benefits and co-payment need to be re-examined. The integration of acute care with post-hospital care is critical to assure the continuity and comprehensiveness of services.