- 期刊
長期醫療照護系統復健費用分析：以某綜合醫院腦中風患者為例
Rehabilitation Cost of Long Term Care System - Analysis of Stroke Patients Sampled from a General Hospital
摘要
全民健保開辦後，醫療給付與老人長期醫療照護相關者只有居家照護一項，並不涉及復健醫療，其財務無法負擔長期照護費用應為主要因素。日本自1963年高度經濟發展時期走「高福祉國家」的路線，造成醫療的濫用、費用的高漲及急性病床幾被老人慢性病患佔據，也使國家財政日益惡化。1983年後以綜合性保健醫療照護提昇國民保健，但提高老人自負額，並設置醫療費用較低之「老人保健設施」，又以居家護理、日間照護、在宅照護將老人留在社區內。前車之鑑，在我國尚未全面實施長期照護之時，應該多方評估資源分配之成本效益，是否能做完全免費之醫療保健照顧，或者該將復健醫療歸醫療，而養護歸社會福利機構。 本研究以腦中風為追蹤依據，計算醫院住院、日間照護、居家照護患者各類費用消耗金額，依病程考慮慢性病急性、亞急性及慢性期之醫療、復健和養護需求，發現愈在急性期，醫療及養護需求所需金額皆愈高；反之，病程趨向慢性期，醫療及養護需求所需金額皆降低；復健需求則在急性末期、亞急性期及慢性初期較為顯著。若觀察醫療費及養護費與總金額的比率，發現在急性期，醫療需求比率較高；病程趨向慢性期，養護需求的比率漸增，但與病程無明顯線性相關。 為降低健保財務負擔並提昇復健醫療品質，在規劃未來的長期醫療照護給付，尤其在疾病亞急性期，全民健康保險應考慮給付各種有效率的復健醫療模式。
並列摘要
Following implementation of the national health insurance system in Taiwan, only home health care is covered by insurance for long-term-care, possibly owing to the lack of financial coverage. Since Japan's economy reached full maturity in 1963, social benefits, including free health care, have been provided. This subsequently led to abuses of health care resources, cost expansion and acute beds occupied by chronic patients, thus straining governmental finances severely. This situation has been alleviated by providing general health care, elevating the deductable amount, constructing less expensive health facilities for the elderly, and performing home health care, day care and home nursing so that patients can remain in the community. In contrast, Taiwan's national health insurance has not drawn up a comprehensive schedule for long-term care. If such care is initiated, rehabilitation and medicine, not daily life care, should be included in health insurance payments. This article describes 646 stoke patients admitted to a selected hospital from June 1996 to Nov 1996. Patients were distributed at acute bed, day care center and home care. Notably, although medical fee and daily care fees are highly elevated during the acute stage, both drop off during the chronic stage. Rehabilitation fee is largely elevated during the subacute stage. Although the percentage of medical fee is higher during the acute stage, and daily care fee is higher during the chronic stage, no linear relationship exists.