Abstract It is noted that the major driving forces of development of subacute care market include the prospective payment system such as DRGs TW-DRGs payment policy started in January of 2010, and will be completely implemented during the coming 5 years. And it is expected that some of the untoward reactions of the medical care providers will change its structure and behavior in response to the financial fluctuation and operation risks¡Athis conditions give birth to the subacute care market. The purpose of the study includes (1)Estimation of the potential subacute care market raising by the impletement of the TW-DRGs payment policy. (2)How can the present medical service providers pave the way to joint the subacute care market. (3)Is there a chance to establish a new service model according to the operation circumstance in Taiwan!? Our study of subacute care and these issures involved an extensive literatures and documents review as well as interviews with knowledgeable experts from around the sourthern part of the country (including professor of medical college and management college, CEO of hospitals and nursing facilities and officer of public health department ) quantiatative analysis of the collected data was done. We came to a conclusion that there will be enomerous demand of subacute care market and there is no so-called subacute care provider noted in the Taiwan medical service system. The imbalance between demand and supplyment will lead to a chance of developing a new service model acccoding to the specific requirement of the people. Since patients and providers will response to the payment system designed and executed by the policy-maker of the government, our suggestion of policy implication about setting up the subacute care system include : 1. Defining subacute care clearly. 2. Recognizing proper requirements of providers. 3. Identifying rational clinical approach. 4. Improving patient placement and transfer process. 5. Ensuring that the care is reimbursed adequately and appropriately. Key Words: TW-DRGs¡ASubacute Care¡AStrategy

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.