重大傷病與殘障患者使用健保門診復健相關治療之分析

Utilization of Outpatient Rehabilitation-Related Therapies by Patients with Catastrophic Illness and Disability under the National Health Insurance Program in Taiwan

吳英黛(Ying-Tai Wu) ； 張祐仁(Yu-Jen Chang) ； 楊政峰(Jeng-Feng Yang) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 27卷1期 (2002/02) Pp. 1-9

摘要

目的：分析復健相關各專業治療在門診業務中對重大傷病、殘障以及其他類病患之服務狀況。方法：以健保局提供之86、87年度l至4月台灣地區復健相關治療門診申報的完整資料中，分出重大傷病、殘障以及「其他」三類別的病人，探討其使用門診復健相關治療的情形。結果：86、87年度l至4月利用復健相關治療之人次，重大傷病者從佔1.8%增至2.2%，殘障病人則從1.0%增至1.7%，「其他」類別則從97.2%小降至96.1%，與一般觀念中復健相關治療的對象大多為殘障者明顯不同。有關各專業治療之利用，各類別患者均以使用物理治療為大多數；在重大傷病部分，物理治療約佔總服務量之70%，區域以下醫院所佔比例略多，而殘障患者使用復健治療之總人次中，86年物理治療人次占68%，87年佔53%，均以區域以上（含）醫療院所為主，而其他類病人使用物理治療兩年均佔90%以上，且絕大多數是在區域以下醫療院所。復健科的確較非復健科服務了較多數的殘障病人，但多集中於區域以上之醫療院所，復健科診所對殘障病人的服務甚至遠低於非復健科診所。結論：殘障患者尋求門診復健治療的可近性顯然不足。建議以健保支付方式誘導對重大傷病、殘障病人合理的復健照護，例如加強出院前復健需求的評量，建立出院後居家或社區物理治療的轉介與提供服務的制度。

關鍵字

復健相關治療 ； 重大傷病 ； 殘障 ； 門診健保支付

並列摘要

Purpose: To examine the utilization and growth of rehabilitation-related therapies for catastrophic ill, disabled, and other types of patients in regard to level of health services, and the referring departments (rehabilitation and others). Methods: This study was based on the rehabilitation-related therapies outpatient data from January to April in 1997 and 1998 provided by the Bureau of National Health Insurance in Taiwan. Four therapies (general, physical, occupational and speech therapies) were processed and analyzed by three patient categories, two institutional levels, and two referral sources (rehabilitation or other departments) using SAS software. Results: Utilization frequency of patients in 1997 and 1998 (January to April) with catastrophic illness was 1.8% and 2.2% respectively, 1.0% and 1.7% for disabled patients. Seventy percent utilization in catastrophic illness and 90% in other types of patients were physical therapy and mainly at local hospitals and clinics, while 53%-68% utilization by disabled patients in physical therapy was for regional hospitals and medical centers. Disabled patients had low utilization of rehabilitation-related therapies at local hospitals and clinics and even lower rate of services at rehabilitation doctor clinics. Conclusions: Poor availability of rehabilitation-related therapies for disabled patients was noted. We suggested more rational use of rehabilitation-related therapies and systemic referral for home and community care for those with catastrophic illness or disability.

並列關鍵字

Rehabilitation-related therapy ； Catastrophic illness ； Disabled ； Outpatient services