Concerning the baseline confounding factors for deteriorating care needs level, higher age is an understandable factor for deterioration of physical or mental functioning of users in the lower care needs level subgroup.
One of the key obstacles to an informed debate is lack of public trust; it is hard to convince people that a tangible hospital service will be replaced by a community-based one, or that reducing beds can be a sign of improving, rather than deteriorating, care.
Both the Berwick and Keogh reviews 6 9 have emphasised the need to seek out the patient voice as an essential and timely warning sign of deteriorating care.
We can conjecture, however, that there are two possibilities to explain why some service use showed a significant relationship with a deteriorating care needs level: (1) user's potential to deteriorate, not effect of service use; and (2) the effect of service use.
As a result, in the lower care needs level subgroup, higher age (OR = 1.04; CI, 1.01-1.08), more use of respite stay in a nursing home (OR = 2.55; CI, 1.39-4.56), and a greater number of types of care services during the 11 months (OR = 1.33; CI, 1.02-1.74) were included in the final model and significantly related to a deteriorating care needs level.
On the other hand, frail elderly often have deteriorated oral care because of impaired vision and manual dexterity, diminished muscle control and oral status susceptible to oral plaque accumulation (Walls and Steele 2001).
With our own national health program we could improve incentives that would reinforce our rapidly deteriorating primary care infrastructure.
This misallocation of trained medical talent is in some measure responsible for the deteriorating health care infrastructure in these countries, particularly in secondary and rural health centers.
For years, North Koreans fleeing their country have told of a deteriorating health care system, especially after the collapse of the economy in the mid-1990s.
By the early 1980s, deteriorating health care services deterred the general public from using government facilities and some patients only used these facilities when their health conditions were critical.
