- 學位論文
機構式長期照護需求之影響因素及建構長期照護體系之雛議
Factors Affecting the Demand for Institutional Long Term Care and a Model for the Long Term Care System
摘要
本研究在找出影響中高齡者機構式長期照護意願需求的顯著因素，並觀察經濟因素加入前後，是否改變其他因素的影響，及經濟因素本身是否有顯著影響。由1999年的台灣地區調查中，篩選出50歲以上符合條件者，計有3,182位，以邏輯迴歸分析經濟支持、特徵背景、健康狀況、照護人力與態度看法因素對長期照護意願需求的影響。就全樣本而言，有經濟支持的迴歸結果中，有無工作、是否有預備存錢、地域別、生病有無依靠及未來居住環境之選擇為顯著影響因素。若抽離出經濟支持變數，顯著因素則為地域別、婚姻狀況及生病有無依靠。經由1999年的調查中，得知機構式護意願需求影響因素中，經濟支持因素的加入在50至64歲樣本顯著增加解釋力。不過，對於65歲以上的樣本，本研究進行其他變數組的概似比檢定發現，「照護人力」變數的納入，會顯著提高迴歸式的解釋力。因此，政府應針對不同年齡族群規劃長期照護政策。 其次，探討日本與臺灣高齡者長期照護體系與政策，包括長期照護保險、長期照護制度的優缺點及提出未來改革方向。日本在1970年，65歲以上人口比例達7%，步入高齡化社會。1995年時，高齡者比例即達14%，倍增速度僅需時25年，可見人口高齡化速度之快，且日本目前為世界上平均餘命最長的國家。在人口極快速高齡化及家庭照護資源漸減情形下，日本長期照護體系的建構實為當下的重要議題。探討過日本之後，檢討臺灣的長期照護政策，並藉由對日本長期照護體系的檢視，提出可給臺灣的政策意涵。 最後，根據對日本與臺灣長期照護政策的討論，本研究以臺北市為例，規劃高齡者健康照護體系，包括心理及身體健康，以確保高齡者權益。並期使臺北市成為高齡者之模範市，作為臺灣其他縣市學習與效法之對象。從過去、現在及未來的臺北市高齡者政策可知，衛生及社會部門皆有部分的規劃及管理權，因此建議統籌設立一「高齡局」，以統一政策之執行及資源之配置。此外，將臺北市劃分為4個次網絡，並分項規劃建構理想之照護體系，包括所得保障、醫療提供、居家(住宅)安置、社區性照護服務及生活滿意之維持與促進。其中最重要的是「醫護之家」的成立，提供高齡者綜合性的照護服務。最後，由點至線而面建立起全市24小時的高齡者援助中心網絡。不過，更細部的規劃仍待後續研究。
並列摘要
First, this study investigates the determinants of the notional demand of institutional long term care of middle and old aged people. In particular, this study examines whether financial support is one of significant factors. From a national investigation in 1999, we choose those who are over 50 years old with the total number 3,182. This study uses logit model to analyze the effects of financial support、characteristics、 health status、caring human resources and attitude factors on the notional demand of long term care. When we employ financial support factors, we obtain the following significant factors: whether the interviewees have jobs、saving beforehand for the elderly life、 area、 whether receiving care when sick and the attitude. Without financial support factors, we obtain the following significant factors: area、marriage status and whether receiving care when sick. From investigation in 1999, area and dependence are stable significant factors no matter whether we employ financial support factors or not. By Likelihood Ratio test, we can know that the financial support factors significantly affect those 50 to 64 years old people. However, for those above aged 65, by likelihood ratio test of other variables, we find that caring human resources factors significantly increase the explanatory power of the regression. Therefore, our government should establish long term care policy aiming at different age groups. Next, we discuss the health care system and policy for the elderly in Japan and Taiwan, including long-term care insurance in Japan、the advantages and disadvantages of the long-term care system and future reform. Japan has become an aged society since 1970, when the rate of the 65+ population was up to 7%. In 1995, the aged population rate was already up to 14%, which means it only took Japan 25 years to double the rate. Japan has experienced quite rapid progress in population aging. Moreover, Japan has the longest life expectancy in the world now. Under the condition of rapid aging and diminishing family care resources, the construction of the long-term care system and policy is really important. After discussing Japan’s long term care system, we review Taiwan’s long term care system. By observing Japan’s system, we refer to some policy implications. Finally, according to the discussion about the health care system and policy for the elderly in Japan and Taiwan, we establish a health care system of Taipei elderly, including both mental and physical health, which ensures the rights and interests of the elderly. In addition, we hope Taipei can become the model city of the elderly, and other cities can learn much from Taipei. From the past, current and future elderly policy in Taipei, we can know both health and social sectors have the design and management rights. Therefor, we suggest establishing an “Elderly Bureau” to unify the implementation of the policy and the allotment of the resources. Besides, we divide Taipei into 4 sub-networks, and construct the ideal care system orderly, including income protection, medical care provision, housing arrangement, community care service and promotion of the living satisfaction. The most important is the establishment of “Medical-Nursing House”, providing the comprehensive care for the elderly. At last, a whole day and night elderly helping center network is established. However, the further detail planning needs to be researched in the future.