全民健保制度與復健醫療發展－以台灣中區為例看復健醫療資源分佈及其未來走向

The Influence of National Health Insurance Policy on Rehabilitation Medicine ---- Current Resource Distribution and Perspectives in Rehabilitation Medicine in Central Taiwan Area

畢柳鶯(Liu-Ing Bih) ； 連倚南(I-Nan Lien)

《中華民國復健醫學會雜誌》 25卷1期 (1997/06) Pp. 65-72

https://doi.org/10.6315/JRMA.199706.0065

摘要

本研究以民國八十四年六月台灣中區四縣市所有提供門診及住院復健醫療服務院所申報的復健醫療總金額、醫療費用明細金額對應醫療院所型態、醫療院所人力設施作資源運用及產能分析，以瞭解目前復健醫療資源在中部四縣市的分佈狀況，並探討全民健保制度對未來復健醫學的發展造成何種影響。
六十二家醫療院所共申報醫療費用五千一百五十七萬餘元，其中復健科住院費用六百四十一萬餘元(12.4%)，提供傷殘病患之門診功能復健醫療費用八百一十五萬餘元（15.8%），專任復健科醫師督導之骨骼肌肉系統疾病門診物理治療共兩千四百零三萬餘元（46.6 %） ，兼任復健科醫師督導之門診物理治療約七百七十九萬餘元(15.1%) ，以骨科為主的非復健科醫師申報之門診物理治療約五百一十入萬餘元( 10.1%)。複健治療費用中物理治療佔89.8% ，職能治療佔9.4% ，語言治療佔0.8%。門診收入中每位治療師之月平均產能約為14萬元，其中五家院所每位治療師之月平均產能超過30萬元，但住院為人平均每日申報費用僅1，833元。建議參考人力、心力與設施等成本修訂全民健係復健科之支付標準， 以免治療不同類型疾忠之投資報酬率差距過大，加速復健醫療次專業之不均衡發展。

關鍵字

復健醫學 ； 健保

並列摘要

The objective of this study is to determine the distribution of medical resources for rehabilitation in the central Taiwan area (including three counties and one provincial city) and foresee the possible influence of National Health Insurance policy on rehabilitation medicine.
The subjects of this study were sixty-two hospitals or clinics in the central Taiwan area that instituted rehabilitation outpatient and/or inpatient medical services in June of 1995. Among them, four provided comprehensive rehabilitation medical services for inpatients as well as outpatients; nine had outpatient physical, occupational, and/or speech therapy departments; twelve employed full-time physiatrists but provided physical therapy only; seventeen employed part-time physiatrists and only provided physical therapy; and remaining twenty provided physical therapy supervised by non-physiatrists.
The total amount of rehabilitation medical charges declared by these hospitals or clinics in June 1995 was NT$51,573,930. Hospitalization charges totaled NT$6,410,000 (12.4%); medical charges of outpatients with major disability were NT$8,153,067 (15.8%); charges for physical therapy under supervision of full-time physiatrists for outpatients with musculoskeletal diseases were NT$24,030,589 (46.6%); charges for physical therapy under supervision of part-time physiatrists for outpatients mainly with musculoskeletal diseases were NT$7,778,812 (15.1%); and, finally, total charges for physical therapy supervised by non-physiatrists for outpatients with musculoskeletal diseases were NT$5,184,462 (10.1%). Physical therapy charges account for 89.9% of the total cost of rehabilitation therapy, occupational therapy for 9.4% and speech therapy for 0.8%, respectively. On average, these hospitals or clinics received approximately NT$140,000 per month from the Bureau of National Health Insurance for medical charges in outpatient medical services for each active therapist. The figure could be as high as NT$300,000 per therapist per month in five of these hospitals or clinics. On the contrary, the Bureau of National Health Insurance only paid NT$1,833 per day for each inpatient receiving comprehensive medical rehabilitation. This shows that the difference of investment returns rates for different kinds of rehabilitative treatment is tremendous and, therefore, can worsen the disproportionate development of rehabilitation medicine and physical medicine. Suggested ways to cope with the situation include: (1) revising the payment standards for rehabilitative medical services in the National Health Insurance system to avoid the disproportional development of different sub-specialties in rehabilitation medicine; (2) increasing the amount of payments to inpatients and those with major disability to avoid the shrinkage of the market of rehabilitation medicine for major disability; (3) reimbursing as well as encouraging hospitals to hold rehabilitation wards, and setting a ratio of rehabilitation beds to beds for general patients in order to increase opportunities for patients with major disability to receive rehabilitative medical treatment as soon as possible.

並列關鍵字

rehabilitation medicine ； national health insurance