台灣中期照護的展望

The Prospect of the Intermediate Care in Taiwan

我國的65歲以上老年人口在1993年跨過總人口數的7%，成為聯合國定義的老化國家（aging society），預計在2017年將達到14%，成為老人國（aged society）。由於過去的醫療體系以疾病為導向，對於老年人不典型的疾病表現、多重共病、多重用藥、身心功能退化與失能等，無法面面俱到，加上醫療體系對孱弱老人更是欠缺整體性的治療措施，故需特別健康照護體系如亞急性、中期照護（intermediate care），做為急性與慢性照護之間之照護橋梁。本文將回顧英國中期照護、美國亞急性照護及急性後期照護推行經驗；另台灣目前則是分兩種系統推動：衛生署署立醫院試辦中期照護專案，另退輔會主導榮民醫院體系試辦中期照護服務網。本文並依台灣現況提出中期照護未來發展之建議。

Objectives. The elderly made up 7% of Taiwan's population in 1993. That proportion will reach 14% by 2017, when the nation will become what is known as an aged society. It is common for elderly patients to have medically complex diseases with atypical disease presentation and functional decline. Thus, there is a need for a special health care system that can link the acute care and the chronic care system. Methods. This article reviews the intermediate care system performed in England and the subacute care system as well as postacute care system in the United States, compared to the pilot intermediate care project in Taiwan. Results. In Taiwan, we have two systems, one administering hospitals belonging to the National Department of Health since 2009 and the other hospitals belonging to Veterans Administration since 2007. Conclusions. Intermediate care is one of essential components for the comprehensive geriatric care. This article reviews and makes recommendations about the intermediate care in Taiwan in the future.