失智症患者家屬對機構照顧支付費意願和家庭照顧成本估算與影響因子之探討

The assessment of willingness-to-pay and cost of caregiving for families of the dementia

陳春閎(Chen Chun Hong)

指導教授 ： 屈蓮

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(1998年)

摘要

高齡化社會之趨勢所帶來的老年人口問題在已開發國家中倍受關注。而老年期的病態心智功能退化─失智症在近幾年受到相當的重視。老年失智是一種進行性的疾病，這樣的患者需要長期照顧，但臺灣地區目前衛生行政體系下的長期照護機構均以生理上需要有人照顧之病人為主，而尚無法涵括心理疾病之病人如老年失智症者。由此可知國內有關老年失智病人之長期照護面臨市場之供應不足的問題。且有研究者指出，機構式照顧對中、重度失能的個案而言較符合成本效益原則，因為居家照顧模式需面對相當龐大的家庭成本，所以為這些病人及家屬尋求一妥善的解決之道是迫切的 課 題。因此本研究之執行目的乃是了解老年失智症患者之家庭照顧成本與家屬對機構式長期照顧的使用及付費意願，並探討有關的影響因子。 本研究對象為台北與高雄地區之老年失智症患者之家屬，研究工具採本自擬之基本資料和失智症家屬對機構照護使用及付費意願調查表之結構式問卷以及國內屈氏所發展之慢性病患者的家庭照顧成本估算單，以失智症患者之家屬重新修正此三項測量工具。資料收集方法在病人家屬方面則採電話訪視方式為主。研究之結果發現家庭模式之照顧成本以勞力成本額最高，機構式之照顧成本以機構收費佔總家庭成本額最高，且在兩種照護模式間的成本組合確實有所差異。另外家庭模式之總照顧成本隨著病人失智嚴重度增加而增加，『嚴重度』對家庭照護成本的增加，影響非常明顯。反觀 機構式之照顧成本，不同嚴重度之病人，對家屬所負擔的成本變化並不大。地區方面，研究中發現，在相同的照顧模式下，無論是何種型態的失智症，台北與高雄地區間的照顧成本，使用意願高低和其影響家屬選擇的因素均有顯著的差異。 本研究建議台北地區應以現有的醫療資源增設失智老人日間照護中心，政府更應同時加強協助機構立案，以因應高齡化社會帶來的衝擊。高雄地區則建議以現有的豐富資源，由政府協助未立案的機構，轉型為「失智症照顧機構」，作為其他地區未來發展之典範。

關鍵字

失智症 ； 照護模式 ； 成本分析 ； 付費意願

並列摘要

The rapid growth of the elderly population has resulted in a dramatic change in the number of long-term care patients with dementia in many developed countries. However, specific care for patients with dementia is often not provided because of the absence of obvious physical dysfunction in these patients. As a result, there is a substantial shortage of care for patients with dementia long-term institution care is a more cost-effective choice than home care for persons with moderate or severe dysfunction. Po l icies concerning care of patients with dementia are clearly on need of revision. This study was designed to assess the need for long-term care of family caregiving, and to examine the independent variables. The family caregivers of dementia patients in the Taipei and Kaohsiung Metropolitan Areas were interviewed by phone calls. A cost diary and questionnaire were used to examine the family costs and willingness to pay for nursing home services. The results show that families incurred high labor cost when patients remained at home, and the physical function status significantly influenced the extent of family cost. Pay too nursing home services was the major family costs for patients admitted to nursing home ins titutions. The costs incurred by families and willingness to pay for nursing home services were different in the Taipei and Kaohsiung areas. Our study suggest that to establishment of day care centers should be a priority in developing programs for long-term care of patients with dementia in the Taipei and Kaohsiung areas. The government should also assist illegal long-term care facilities to transfer their patients into legal care facilities.

並列關鍵字

dementia ； care model ； cost analysis ； willingness to pay