Improving services for vulnerable population groups, such as the elderly, and increasing equality in the health system, were among the goals of the National Health Insurance Law. The law stipulated that the health plans were obligated to provide their members, including those who were homebound, with a defined basket of services. This is especially important, given the rapid increase in the number of disabled elderly who are unable to visit health plan facilities in the community. Although the health plans have been providing medical home care for close to 30 years, no organized, comprehensive information was available about these services. This study was therefore intended to examine how the health plans care for their severely and chronically ill homebound members, and to discern differences among the health plans, as regards the following:
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The distribution and accessibility of home care services around the country.
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The scope of the basket of services, the types of treatment, and how services are provided.
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The agencies responsible for providing care, and coordination among them.
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Definition of the appropriate target population, and patient characteristics.
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Health plan policy regarding the provision of medical home care.
As part of this study, in-depth, face-to-face interviews were conducted with some 80 health plan and home care unit managers in medicine, nursing, and administration from around the country.
The findings of the study revealed that all of the health plans have medical home care units in all of their regions, which provide, medical, nursing, and rehabilitative care to members who are unable to visit their facilities. Although there are similarities among the home care units of all four health plans, there are also many, significant differences in the services the health plans provide and even in the home care units in different regions of a given health plan. These differences are reflected in the characteristics of the patients receiving care, the scope of the basket of services provided, the processes of care provision, the medical professionals responsible for the patient and care provision, and the organization of the service. It appears that two severely ill homebound patients with similar characteristics may receive different care, depending on where in the country they live and which health plan insures them.
The findings of the study are a basis for discussion in the health plans and the Ministry of Health regarding the development of policy that will ensure appropriate provision of health services to homebound patients, and determine the appropriate administrative framework for their provision, as befits the organizational structure and work procedures of each health plan. To this end, the findings were presented to the managers of the health plans, and a discussion held regarding their implications and the processes necessary for improving services and ensuring appropriate medical care for all members. The findings were also presented to the Department of Geriatrics of the Ministry of Health, which will use them in its efforts to more clearly define the home care services included in the basic basket of health services.
This study was conducted with the help of a grant from the National Institute for Health Services and Health Policy Research.