Chronic Disease and Its Implication on Long-Term Care

本文以慢性疾病的定義與特性，探討慢性病發展與長期照護的關係，釐清慢性病的鑑定特徵及討論疾病定義的觀點與限制。另外，慢性病盛行率上升所造成的巨大長期照護需求壓力來源，在概念上可歸為失常、功能障礙、及殘障。而我國的法令雖供長期照護機構設置的依據，但法源不同卻造就模糊的機構功能、主管機關事權不清、服務差歧、功能評估制度不完善、及資訊不對稱。且衛生署新近的長期照護功能劃分，雖掌握醫療與照顧兼顧的精神，由於只單純考量人口老化與資源配置的政策問題，對於固有家庭養老功能及健康測量均欠缺周延規劃，除對服務對象身體功能變化無法測定，亦很難落實機構分級與照護移轉。

關鍵字

慢性病；失常；功能障礙；殘障；長期照顧

並列摘要

Taiwan is experiencing increasing prevalence of chronic diseases, which has created stress on Taiwan's long-term care system through the greater demand for care of handicap, functional disorder and disabilities. This paper is to review the definitions and characteristics of chronic disease, evaluate the impact of increased prevalence in chronic disease, and assess how the long-term care meets the challenges of the ageing society. There have been statutes governing the administration of long-term care facilities in Taiwan; yet a quick review of these statutes reveals problems in the system. Some of these problems are: no clear definition of the institutions; confusion in the power and jurisdiction of the agencies; disparties in the rendered services; inadequate functional assessment on admissions; and difficulties resuIted from informational asymmetry between the facilities and the public. The Department of Health has formulated several measures for the long-term care, and has made some progress in integrating ＂cure＂ and ＂care＂ for the chronically diseased, yet there are mainly two areas which need to further addressed by the authorities' policies: one is the definition of family care in relations to the whole long-term care system; the other is the improvment in the instruments for functional assessment. The former should have some bearing on the financial and humane considerations and the latter should help in assigning the diseased to the appropriate facilities.