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home care services, Japan, reimbursement, Relative Value Scales



  1. Ogata, Yasuko
  2. Kobayashi, Yasuki
  3. Fukuda, Takashi
  4. Mori, Katsumi
  5. Hashimoto, Michio
  6. Otosaka, Kayo


Background: Japan's system of Home Visit Nursing Care Stations (Station) began in 1991. To maintain the quality of services in home health nursing provided by Stations, reimbursement needs to account not only for the number of home visits, but also for the time and intensity of nursing services.


Objectives: This study aimed primarily to investigate the total work value and the three dimensions (time, mental effort, and physical effort) of actual visiting nursing services for the aged, and to quantify the contribution made by the three dimensions of nursing services to total work. The secondary purpose was to determine whether patient characteristics, nurse characteristics, and types of nursing services contributed to the variance in total work. Total work is defined as comprehensive work input of nursing services, with careful consideration given to both the intensity and duration of work.


Methods: Self-report questionnaires about actual visiting nursing services, based on the Resource-Based Relative Value Scale, were answered by 32 nurses from three Stations in urban Yokohama, Japan.


Results: Regression analysis showed that time and intensity (physical effort and mental effort) explained 96% the variance in total work. Time alone accounted for only 39% of the variance in total work. Patient characteristics, nurse characteristics, and service type accounted for less variance in total work than did time and intensity.


Conclusions: The study findings indicate that reimbursement of nursing services should reflect not only the time required for each visit, but also the intensity of nursing services provided, including mental effort and physical effort.