建構「衛政」與「社政」的橋樑－－醫院在長期照護中的發展

Bridge between health and social services—the key role of hospital in long-term care for elderly

目的：目前我國對老人的長期照護服務分散於不同之行政與服務體系，綜合 性及連續性之照護體系尚未建立。服務體系的分歧，往往使得需要醫療照護或生 活照顧的老人及其家庭不知所措；且體系間各自發展，不但造成資源重複投資， 亦容易形成發展不均與服務斷層等現象。因此，整合衛政及社政體系，可說是國 家方向及社會共識，而醫院於此趨勢中應該如何發展，也成為必然需要探索的議 題。 方法：回顧我國長期照護體系整合發展，及醫院於目前體制下所扮演角色， 進而提供醫院於整合體制下未來發展趨勢之建議。 結果：醫院應以社區及老人為中心，用整合性照護系統的觀念作為發展長期 照護的策略，建構社政與衛政的橋樑。 結論：醫院可在此趨勢與基礎下，整合發展社區醫療照護服務、運用資訊系 統建置社區健康照護體系、以及與政府社會福利政策體系互動之運作等，尋找可 參與長期照護的角色定位，發展出醫院自己的服務模式。倘若繼以健康促進為宗 旨，醫院便能在衛政社政整合的過程中，扮演積極有效的角色，提升以病人為中 心的照護品質與效能。

Objectives: Currently the long-term elderly services are under different administrative systems in Taiwan. The integrated and continuous services have not yet well established, and the service gain orientations are under different administrative systems. The divergent systems often confuse the needy elderly and their families. And the separated development of different systems does not only duplicate precious resources, but also causes the inequality of health. Therefore, the integration of health and social services is the common will of the society, and the development of the hospital inevitably requires further exploring. Methods: By review the development history of long term care in Taiwan, and the current role of hospital today, the recommendations will be provided for the hospital in the future development of service integration. Results: Hospital needs to develop its long term care strategy through integration of health services with keeping community and elderly as the focus, so as to become the bridge between social and health services. Conclusions: The hospital can develop its own model of long-term care with relevant efforts, such as integrating the community health care, enhancing IT system of community health care, and liaison with political and social resources. With the aims of health promotion, the hospital can then play an active role during the integration of heath and social services, and consequently improve the quality and efficiency of patient-centered care.