給付標準的設定會引導民眾對社區式服務的利用嗎？－以居家服務為例

Effects of Reimbursement Levels on the Use of Home Care Services

曾淑芬(Su-Fen Tzeng) ； 莊坤洋(Kun-Yang Chuang) ； 陳正芬(Chen-Fen Chen) ； 葉乃禎(Nai-Chen Yeh) ； 吳淑瓊(Swu-Chung Wu)

《台灣公共衛生雜誌》 23卷3期 (2004/06) Pp. 221-234

https://doi.org/10.6288/TJPH2004-23-03-06

摘要

目標：為了解社區失能者在不同的居家服務給付方案下，個案實際使用服務的情形與差異性，以及影響服務使用的相關因素。方法：本研究選取六家受台北市政府委託辦理居家服務之機構，並以該六家機構所收案並提供服務的對象為研究樣本，樣本資料係來自服務提供機構的個案記錄等相關資料，收集自89年1月至90年3月期間，各單位新開個案一個月內使用居家服務之相關資料，進行分析，總計取得樣本數為454人，經刪除資料不適用個案後，得有效樣本數為 440 人。結果：（l）將近三分之二的個案其一個月服務使用時數都集中於16小時（63.4%），其中一般戶月服務使用時數為16小時之比例更高達86.1%，而低收入戶在該項的比率則僅有13.8％。（2）低收入戶個案的月使用時數超過16小時以上者佔70 %，且使用的最高時數為96小時（佔13.8%），而非低收入戶月服務使用時數超過16 小時以上者僅佔7.8％。（3）邏吉斯複迥歸分析結果，在控制相關因素之後，低收入戶高時數服務使用（大於16小時）的可能性比非低收入戶多58倍（危險勝算比為57.8），完全依賴個案的高時數服務使用可能性則比輕度依賴者高出6倍（危險勝算比約為5.9）。而個案年齡則與月服務使用時數成正比，未婚者比已婚或同居者有較多的機會使用高時數服務（危險勝算比則為2.8），家庭照顧資源越少者其使用高時數服務的可能性越高。結論：由於政府給付上限設定的不同，使低收入戶與非低收入戶兩類不同身分類別的個案，在居家服務的使用也有明顯的差異，顯示政府給付標準的設定對民眾服務的使用有極大的主導作用，因此，未來在進行長期照護保險的現劃時，有關支付制度的設計，應同時考量民眾的付費能力與實際的照顧需要，以避免服務利用多集中於低收入戶的現象，並能更適當合理的運用照護資源。

關鍵字

給付標準 ； 服務利用 ； 居家服務

並列摘要

Objectives: To investigate the use of home care services and the possible effects of reimbursement levels and other factors associated with the use of services. Methods: Six home care services providers, all under contractual agreement with the City of Taipei to provide services, were selected. Data (n = 454), in the form of documents and clients records, was collected from the providers from January 2000 to March 2001. After the elimination of inappropriate data, the final number included for analysis was 440. Results: (l) About 63.4% of the cases used 16 hours of services a month. Among the 16-hour users, 13.8 % were from low-income households. (2) Among the low-income users, 70% used more than 16 hours per month. Some (13.8 %) used as many as 96 hours a month. For cases not in the low-income group, only 7. 8 % used more than 16 hours. (3) Logistic regression showed that, after controlling for other variables, the low-income (OR= 50.8), severely disabled (OR=7.6), and the unmarried (OR=15.9) were more likely than their counterparts to use more than 16 hours of services per month. Furthermore, being younger, and having more family care resources were associated with using fewer hours. Conclusions: Level of reimbursement has significant impacts on the use of services, as indicated by the wide disparity in services hours used between low-income users and others. In planning for long-term care insurance, in order to avoid the skewing of needs for the use of services towards the low-income group, the design of reimbursement schemes should take into account both the ability to pay and also their level.

並列關鍵字

reimbursement level ； utilization ； home care services

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