臺灣居家照護的軌跡初探

Home Care in Taiwan, Past and Future

居家照護是整體健康服務的一環，也是社區健康營造的重要因素。自從荷蘭人在台灣訓練「疾病慰問師」做為台灣居家照護及家庭訪視的開端以來，台灣居家照護的面貌不斷地改變。明鄭及日據時期，醫師的出診（家庭訪視）是醫師日常診療業務的重要項目。但是隨著科技進步，大型醫院興起，醫療重心集中到醫院，居家照護的角色一度減輕，台灣在1993年，65歲以上人超過總人口7%，正式邁入「高齡化社會」。需要長期照護的慢性病患，漸漸增多，居家照護又日漸受到重視。1990年公務人員保險將居家護理納入給付；1995年居家護理納入全民健保給付。居家照護的健保給付希望能增加非技術性護理及社會服務項目，以減少照顧者的家庭負擔。隨著科技的進步以及醫療的社區化，居家照護必將成為21世紀的重要醫療服務。

Home health care service ate she integral part of the holistic health care. The Dutch colonial government initiated the home care services in Taiwan. House calls and home visits were important daily routines of physicians and public health nurses. However, technical development concentrated in the hospital services and the home care services were less performed. The growth of the elderly makes long term care necessary and the home care services are revitalized. The home care services were reimbursed by the Government Employee Insurance Program in 1990 and was included in the reimbursement program of the National Health Insurance in 1995. The current reimbursement items of the home care services need further expansion to include the care of the daily living and social activities. The provision of home care services for the patients with subacute diseases could possibly reduce the length the hospital stay in lowering the medical cost.