推動以ICF爲基礎的身心障礙者鑑定標準之困境與建議

Difficulties and Suggestions for Disability Evaluation Enforcement Based on WHO-ICF in Taiwan: Exploratory Findings

林金定(Jin-Ding Lin) ； 嚴嘉楓(Chia-Feng Yen) ； 羅慶徽(Ching-Hui Loh)

《身心障礙研究季刊》 7卷1期 (2009/03) Pp. 1-18

https://doi.org/10.30072/JDR.200903.0002

摘要

我國於民國96年7月11日修正通過「身心障礙者權益保障法」，自此身心障礙者乃依據世界衛生組織ICF的分類為鑑定之基礎，有別於以往的16類身心障礙分類方式，這種以ICF八大類分類標準的身心障礙者鑑定標準，對醫療衛生體系是一大挑戰，因此本文主要目的乃以醫療衛生、社福團體與衛生社政官員代表之觀點分析台灣推動ICF制度的困境與其建議，以做為發展ICF診斷標準與工具的參考。本研究資料收集以座談會方式進行，一共進行8場座談會，出席者共有165人次（其中醫療衛生專家98人次，社會福利固體代表50人次與政府主管人員17人次）。座談會進行方式首先由研究人員進行有關於ICF基本概念與編碼原則進行筒報20分鐘，然後由與會人員進行討論與意見交流約1-2小時，資料收集主要以錄音設備（錄音帶、錄音機）及現場紀錄為基本工具，初步資料由研究人員加以紀錄整理後即進行全面性的資料整合分析，主要是以普遍性定義理論、個案摘要、歸納方法等質性方式分析資料。本文結果與討論將按(1)台灣現行身心障礙鑑定制度之問題；(2)對於ICF推動的疑慮分析；(3)ICF中「功能」與「結構」成份問題；(4)ICF中「活動」、「參與」與環境因素、ICF診斷標準發展的一般限制與討論；以及(5)制訂ICF身體功能結構鑑定標準之建議等五部分分析。

關鍵字

ICF ； 功能 ； 結構 ； 身心障礙 ； 身心障礙鑑定

並列摘要

The International Classification of Functioning, Disability and Health (ICF) is a framework and classifications that provide a unified and standard language by which people can describe health, and health related states. Taiwanese government legislated disability evaluation based on ICF framework in July, 2008. It is a tough and comp1icated chal1enge for healthcare and social welfare system. The aims of the present paper were to examine the difficulties and suggestions for Taiwanese ICF initiative based on the stakeholder perspectives of medical care, social welfare and governments. The data col1ection and analysis based on the method of qualitative focus group discussions. We recruited 164 person-times to participate the ICF initiative meetings during December 2008 to January 2009. The participants included medical care professionals (medical doctors or professors), disability and social welfare representatives, health and social welfare governmental officials. The results and discussions will include the fol1owing six dimensions: the problems of provisional disability evaluation, doubts toward ICF framework, questions to body functions and structures, limitations of activity/participation and environmental factors, generic difficulties of ICF framework enforcement and finally, we will make practical suggestions toward the disability evaluation based on ICF framework in Taiwan.

並列關鍵字

Body function ； body structure ； disability ； disability evaluation ； ICF

參考文獻

McCormick, B.P.,Lee, Y.,Jacobson, J.(2004).Operationalizing Community Integration via the ICF.10th Annual North American Collaborating Center Conference on ICF-Advancing a Research Agenda for ICF.(10th Annual North American Collaborating Center Conference on ICF-Advancing a Research Agenda for ICF).:

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WHO(1999).ICIDH-2: International Classification of Functional and Disability, Beta-2 Draft.Geneva:World Health Organization.

WHO(2001).ICF Checklist Version 2.1a, Clinician Form for International Classification of Functioning, Disability and Health.Geneva:World Health Organization.

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