建構長期照護體系先導計畫：實驗社區介入前的照護需求與自付費用

Pilot Program for the Development of a Long-Term Care System: Demands and Out-Of-Pocket Expenses in Experimental Communities Prior to Intervention

10.6288/TJPH2004-23-03-05

吳淑瓊(Shwu-Chong Wu)；莊坤洋(Kun-Yang Chuang)；陳亮汝(Liang-Ju Chen)

社區照護 ； 長期照護 ； 醫療保健服務 ； 身心功能障礙者 ； 照顧需求 ； community care ； long-term care ； medical and health services ； disable ； demand for services

台灣公共衛生雜誌

23卷3期（2004 / 06 / 01）

209 - 220

繁體中文

目標：本研究的目的在分析社區身心功能障礙者的照顧需求，供社區照顧網絡建構與評估之參考。利用服務使用情形估算醫療保健、正式長期照護、和家庭照顧等三類服務的費用支出。方法：研究資料來自「建構長期照護體系先導計畫」嘉義與三鶯實驗社區實驗介入前的調查資料；兩社區共有43萬5千人，其中具有日常生活活動、工具性日常生活活動、或認知功能障礙者，即為本研究樣本；以面對面訪視收集服務使用和費用支出資料。結果：約三成的個案在過去一年使用住院和急診服務，約三分之二在一個月中，曾經看西醫門診。在長期照護方面， 72.1％完全由家人照顧，毫無外力協助；10.1％入住機構；僱用家庭監護工者14.1 %；6.6％使用社區正式服務。因此目前需要照顧的民眾除進機構，或僱用監護工外，很少有其他選擇。具有五項以上日常生活（activity of daily living, ADL）障礙或認知功能障礙，是個案入住機構或僱用監護工的重要決定因素。社區一個月自付醫療保健總經費合計兩百萬，其中七成用在西醫門診上，用於住院和急診不到8 %，可見全民健保對重大傷病的風險分攤作用；長期照護總費用約5,900 萬，家庭照顧者付出機會成本所佔比率最大，佔77 . 8 %，機構式服務佔10.0%，僱用家庭監護工佔11.8％。以上費用支出的估算並不包含全民健保給付、入住機構者的醫療保健支出、家庭次要照顧者薪資等；也並未包含照顧者負荷、因照顧而產生的照顧競爭、工作衝突等無形的負擔。結論：七成以上民眾的長期照護需求完全由家人照顧，入住機構和僱用家庭監護工為目前主要的外來協助，都在一成左右。社區式的照顧對民眾的幫助十分微少，是未來建構「在地老化」照顧體系的一大障礙。

Objectives: To assess demand for services among the disabled in the community, and to provide baseline information for establishing a community care network for the disabled, Based on the current level of service utilization, this research intends to estimate the costs of medical care , formal long-term care, and family care. Methods: Data were collected in the baseline survey from two experimental communities (Chia-Yi City, and San-Yin area of Taipei County) selected for the Pilot Program for Long-Term Care Development. Eligibility for inclusion into the sample was having a disability in the activity of daily living, instrumental activity of daily living, or cognitive function. Out of the 435,000 residents in these two communities, those residents deemed eligible were interviewed face-to-face. Information regarding medical care, long term care, and family care were collected as the basis for cost estimates. Results: About one-third of respondents had been hospitalized in the past year. About 30% of respondents used emergency services. About two-thirds had had physician visits in the past month. As for long-term care, 72.1% depended solely on family members, 10.1% were institutionalized, 14.2% had hired an aid, and 6.6% used community-based care. Little alternative existed besides institutionalization and personal aid. The main determinants for institutionalization or hiring an aid were cognitive disability and ADL (5 items or more) disability. The total out-of-pocket medical expenses for the two communities over a month was about $ NT 2, 000, 000. Seventy percent was spent on physician visits, and less than 8% on hospitalization and emergency care. The cost of long-term care was estimated at 59 million, of which 77.8 % come from opportunity cost of family caregivers, 10% from institutional services, and 11.8% from personal aids. The cost estimation did not include reimbursement from National Health Insurance, the opportunity cost of a secondary caregiver, and caregiver burdens. Conclusions: Most of the long-term care is provided by family members, followed by institutionalization and personal aid. Community-based care only made up an insignificant percentage, representing a barrier before reaching the goal of “Aging in Place.”

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