老年照護醫師人力的未來發展

A Preliminary Study on the Future Development of Physician Manpower for Elderly Care

吳肖琪 ； 陳欣

《台灣老年醫學暨老年學雜誌》 10卷3期 (2015/08) Pp. 146-158

https://doi.org/10.29461/TGG.201508_10(3).0002

摘要

未來十年台灣面對人口老化、全民健康保險收入減少的雙重壓力下，衛生福利部勢必將從以論量為主的支付制度，朝論診斷關聯群(Diagnostic Related Groups, DRGs)、論價值、包裹式、論質或論人支付制度改革做改變。隨著人口的老化，對於老年照護醫師人力的需求會大幅增加，除了小兒科等少數科外，各專科醫師都要有提供老年照護的能力；住院改成前瞻性支付，會使醫院住院日數減短進而減床，有更多的醫師人力投入門診、社區及居家式照護。建議老年照護醫師人力訓練應朝向強化醫師老年醫學照護的能力、引導病人朝活躍老化、健康的生活型態、及預防跌倒與失能等努力；基層醫師亦需具備常見急性後期老年病人之照護能力；另外，醫院須及早強化住院部門整合式照護的能力，以因應支付制度的改變。

關鍵字

老人 ； 醫師人力 ； 支付制度 ； 整合式照護 ； 急性後期照護

並列摘要

Under the double pressure of its rapidly aging population and the declining revenues of its National Health Insurance, the Ministry of Health and Welfare in Taiwan may have to shift the NHI payment system from the current fee-for-service basis to DRG (diagnosis-related group) payment, bundled payment, value based payment, pay for performance or capitation payment so as to tackle the upcoming challenges in the next decade. The number of physicians involved in elderly care will rise along with the aging population. Most physicians should therefore be prepared and qualified for geriatric care. Implementing a prospective payment system (PPS) to reimburse hospitals for inpatient care should help shorten length of stay, thereby leading to a decrease in the number of beds in hospitals. More physicians will then be able to participate in outpatient, home, and community care. Medical education should emphasis more on geriatric care and the promotion of active aging, healthy lifestyle, and prevention of fall and disability. General practitioner should also be capable of providing post-acute care services for elderly patients. Furthermore, hospitals need to strengthen their integrated care capacity to cope with the change in payment system.

並列關鍵字

elderly ； physician manpower ； payment system ； integrated care ； post-acute care