應用德菲法評估人口老化對中醫醫療政策影響

Utilizing the Delphi Method to Plan Optimum Health Care Policies for Implementing Traditional Chinese Medicine in an Aging Population

洪錦墩(Chin-Tun Hung) ； 李卓倫(Jwo-Leun Lee) ； 宋文娟(Wen-Chuan Sung) ； 郭慈安(Tsu-Ann Kuo) ； 施雅文(Ya-Wen Shih)

《臺灣中醫科學雜誌》 4卷2期 (2010/02) Pp. 59-69

https://doi.org/10.29810/SJTTCM.201002.0008

摘要

研究目的：人口老化對整體醫療照護體系有相當大程度影響，醫療照護體系應如何調整因應人口老化對醫療需求質與量上之需求變化是未來政策規劃之重點，因應慢性疾病及無法治癒疾病之醫療照護增加，中醫醫療服務有其不同西醫醫療服務特質，在面臨人口老化議題時中醫醫療體系應如何因應與調整。本研究將透過德菲法擬由中醫領域之學術界與實務界專家對未來中醫醫療體系的政策意見加以整合，提供中醫界未來發展之參考。 研究方法：本研究採用專家德菲法，希望能透過德菲問卷填答回覆整合專家意見，選取台灣地區關於中醫醫療實務界與學術界專家共計21位，進行二回合專家問卷，運用描述性統計進行資料量化分析，問卷第一回合回收率80.95%，第二回合回收率100%。 研究結果：經過二回合德菲專家回饋問卷的結果，專家學者意見認為人口結構改變，對中醫醫療利用有所改變；在應建立中醫診斷基準及治療指引部份，專家認為中醫需要有自己一套的診斷基準與治療指引，而不是與西醫用相同一套；多數專家認為未來10年中醫就醫科別會有較大的需求量為內科、針灸科與傷科，台灣應發展中醫專科醫師制度的時間點為4至6年內，並建議宜由行政院衛生署中醫藥委員會來負責主導推動較恰當。 結論與建議：人口老化對未來中醫醫療服務利用量與費用學者專家認為有相當程度影響，且政策上有必要就長期照護機構部分強化中醫醫療服務供給。中醫醫療若要發展專科制度是否要與中醫健保支付關連應一併考量，中醫診斷及治療標準化應是強化之重點，中醫醫療專科化發展建議經相當時間加以考量與規劃再予以推動。

關鍵字

人口老化 ； 中醫醫療 ； 德菲法

並列摘要

Research Purpose: This study utilized the Delphi method to examine the views and priorities of professionals in academics and practice as they plan health care policies that integrate traditional Chinese medicine as population ages.
Methods: Two rounds of Delphi surveys among 21 experts were conducted with the response rates of 80.95% and 100%. Descriptive analysis was employed for data analysis.
Results: The participants believed changes in population structure would affect service utilization of traditional Chinese medicine both in quantity and quality. Unlike views in Western medicine, the participants held that policy planning for traditional Chinese medicine should focus on diagnostic benchmarks and treatment guidelines. They also indicated that specializations in Chinese traditional medicine should be established within the next four to six years, with internal medicine, acupuncture and Traumatology thought by most to be the top three areas of need. Finally, it was suggested that the health care delivery system and the development of specializations in traditional Chinese medicine would be most appropriately administered and credentialed by the Chinese Medicine Committee of the Department of Health in the Executive Yuan.
Conclusion and Suggestions: The experts believed population aging would affect the usage and fees for Chinese traditional medicine. Thus, enhancing the current health care delivery system and developing the long term care policy to integrate and deliver Chinese traditional medicine should be the two most important missions for planning health care policies in an aging society. The approaches should focus on the standardization of diagnoses and treatments, as well as on deciding whether to develop additional specializations in traditional Chinese medicine with appropriate health care system reimbursement.

並列關鍵字

Delphi method ； Traditional Chinese medicine ； Population Ageing