| Summary: | 碩士 === 大葉大學 === 生物產業科技學系碩士在職專班 === 98 === This research project focuses on the welfare for the aged, chronically ill patients from a single institution's Geriatrics medicine experience, Han-Min General Hospital. From the population of patients admitted from various Nursing Homes, a statistic and a comparison is made with the normal population based on the top 10 admitting diagnosis for both groups, both from the in- and out-patient department of the same annual year. From these statistics, analysis and comparison were made between the two populations, with the aim of detecting any similarities or differences of. Results of the analysis showed that despite the humanitarian society we have, the results were not ideal as we may expect, mainly because of the Nursing Homes' profit-oriented disposition, resulting to lower quality of care, and a higher out-patient consultation and admission rate (17.4%) than that of the normal population (7.5%)--2.32 times higher. This high consultation rate resulted to unnecessary expenses in medical resources, and a drain to the government’s health insurance funds. For outpatient consultations, from a medical perspective, on the average, a single visit costs NT$1158 for a Nursing Home patient, compared with a national average of NT$869, which is 13.32% more. This increase in cost is likely caused by the former patients’ higher age group, with its associated chronic illnesses. For hospital admissions, on the average, a Nursing Home single hospital admission costs NT$33652, which is lower than the national average of NT$38756. This is likely caused by the more frequent hospital re-admissions with shorter hospital stay under the care of Nursing Homes, thus a lower average cost per admission. It is also noted from the analysis of the top ten causes for outpatient consultation or hospital admission, while acute illness is the primary reason of admission for the general population, chronic illness is for the Nursing Home patients. It also indicates that the ongoing government's 10-year patients' Long -term care plan needs to put more effort in monitoring and guiding various Nursing Home Institutions to keep cost down from rising rates of outpatient consultation or hospital admission. From the results which showed that these two populations (the normal population and Nursing Home population) are markedly different, proves also the reason for the evolvement of disease for each of them are also markedly different. This deserve further analysis .This research's data (thanks for the various Nursing Home institutions' cooperation), showed entrepreneurship as their primary goal, translating to more outpatient consultations and hospital admissions. The government, while setting the policy for chronic care training plan, needs also to address the issue of entrepreneurship, and to give support and incentives, to enable successful implementation of government policies among Nursing Home institutions. This will enable the government's "Chronic Care 10-year Plan" to swiftly attain its goal of being both a "Society Model" and a "Medical Model". We hope that the government and other related institutions involved in the policy-making and planning of "Chronic Care 10-yea Plan" take considerations of our research results. Outpatient consultations, from a medical perspective, on the average, a single visit costs NT$1158 for a Nursing Home patient compared with a national average of NT$869, which is 13.32% more. This increase in cost is likely caused by the former patients’ higher age group, with its associated chronic illnesses. For hospital admissions, on the average, a Nursing Home single hospital admission costs NT$33652, which is lower than the national average of NT$38756. This is likely caused by the more frequent hospital re-admissions with shorter hospital stay under the care of Nursing Homes, thus a lower average cost per admission. It is also noted from the analysis of the top ten causes for outpatient consultation or hospital admission, while acute illness is the primary reason of admission for the general population, chronic illness is for the Nursing Home patients. It also indicates that the ongoing government's Long-term care 10-year patients' plan needs to put more effort in monitoring and guiding various Nursing Home Institutions to keep cost down from rising rates of outpatient consultation or hospital admission. From the results which showed that these two populations (the normal population and Nursing Home population) are markedly different, proves also the reason for the evolvement of disease for each of them are also markedly different. This deserves further analysis. This research's data (thanks for the various Nursing Home institutions' cooperation), showed entrepreneurship as their primary goal, translating to more outpatient consultations and hospital admissions. The government, while setting the policy for chronic care training plan, needs also to address the issue of entrepreneurship, and to give support and incentives, to enable successful implementation of government policies among Nursing Home institutions. This will enable the government's "Chronic Care 10-year Plan" to swiftly attain its goal of being both a "Society Model" and a "Medical Model". We hope that the government and other related institutions involved in the policy-making and planning of "Long-term care 10-yea Plan" take considerations of our research results.
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