- 期刊
實施全民健保對住院病患使用復健性治療之衝擊
The Impact of the National Health Insurance Scheme in Inpatients' Utilization of Rehabilitative Therapies
摘要
全民健保開放骨科、神經料、神經外科、整型外料四個急性專科可直接使用復健性治療（復健性治療中，以物理治療介入急性醫療服務佔大宗），與全民使保改依醫院評鑑層級給付復健治療部分費用後，對住院病患復健醫療相關服務（物理治療）造成的衛擊為何是本研究之目的。為能比較健保介入造成之影響，以83年下半年公、勞、農保住院利用，與健保84年下半年中之公勞農保人。進行比較。結果發現健保之公保住院人口的復健性治療項目之利用率從83年的4.9%增加為5.9%，而健保之勞農保住院人口的復健性治療項目之利用率從83年的5.8%、8.3%下降至84年的4.9%、8.1%：依科別看，但五個專科使用復健性治療的比率皆上升；復健科的復健性治療使用人次少（佔6.3%） ，但花費的復健性治療費源最多（佔27.1%），相對而言，骨科的物理治療使用人次最多（佔25.1%），與其他三個專科合計共計花費的物理治療資源卻不多（佔15.3%）。顯示有必要正視物理治療在急性醫療上的重要性。隨著人 p 老化，規畫復健人力方向時，應將急性物理治療與復健性物理治療之需求分開，以便培訓適量適所之復健人才。
並列摘要
The National Health Insurance implemented in 1995 opened the direct access of rehabilitative therapies to four specialties including orthopedic, neurology, neurological surgery, and plastic surgery, and revised the payment method of rehabilitative therapies according to the levels of hospitals. The purpose of the research concerns the impact of these differences from previous insurance plans on the inpatient care of rehabilitation medicine and relative services. In order to know the impact of this new health insurance plan on rehabilitative therapies, we made some descriptive statistics of Government Employee, labor and farmer insurers receiving inpatient care in 1994 and 1995. The result showed that the order rate of rehabilitative therapies for government employee increased from 4.9% in 1994 to 5.9% in 1995, for labor insurers decreased from 5.8% to 4.9%, and for farmer insurers decreased form 8.3% to 8.1%. Regarding the specialty use of rehabilitative therapies, for government employee insurers, rehabilitation decreased the occupancy rate from 9.9% to 7.8% and orthopedic increased the occupancy rate from 16% to 25%. And for labor and farmer insurers, rehabilitation and orthopedic both increased largely the occupancy rate within the specialty use of rehabilitative therapies. Regarding the order rate of rehabilitative therapies among different levels of hospitals in 1995, the higher level of hospitals in rehabilitation, the more order rate. The condition was totally opposite in 1994. Those indications showed that we need to clarify the role of physical therapy in medical care system. As followed by aging, we should clarify the need of physical therapy in rehabilitation care and acute care in order to plan the right staffing of physical therapy.