不同照顧場所之中風失能老人復健照護利用及其長期照護政策意涵

Utilization of Outpatient Rehabilitation for Disabled Elderly Stroke Patients in Different Care Settings and Its Implications for Long-Term Care Policy

台灣地區老人疾病型態改變，家庭照護功能逐漸式微的情況下，長期照護已成為國家必須積極介入的政策，中風失能老人對於復健治療需求與利用高，如何有效配置資源成為重要議題。本研究目的為瞭解中風失能老人復健醫療資源利用情形，並分析不同照顧場所之中風失能老人復健醫療利用的差異。研究方法：以台灣中部地區65歲以上中風失能老人共6,335人為研究對象，利用全民健康保險醫療院所申報資料進行分析。研究結果：在台灣中部地區65歲以上中風失能老人接受復健治療者中，照顧場所為一般居家者占77.65%、護理之家住民占10.31%、安養護機構住民占12.04%。在每人年復健治療總次數中，居家組平均次數為131次，護理之家214次，安養護機構211次，在控制相關變項後，安養護機構及護理之家在每人年門診復健總次數及每人年門診復健總費用上皆高於居家組；在門診復健總次數上以照顧場所為安養護機構者高於護理之家及居家組，而在門診復健費用上則以護理之家高於安養護機構及居家。結論：護理之家及安養護機構場所之中風失能老人在門診復健次數及費用明顯高於居家老人。本研究結果可作為全民健康保險復健管理參考依據、長期照顧保險復健費用之推估及未來長照制度與健保復健的銜接規劃。

Recent changes in patterns of disease occurrence and family care for the elderly have lead to various long-term care issues concerning care quality and resource allocation in Taiwan. This study tries to investigate the patterns of utilization of the rehabilitation service among the stroke elderly with disability and the difference of utilization among various long-term care settings. The outpatient reimbursement claim data of the National Health Insurance in 2008 was retrieved. A total of 6,335 disabled stroke elderly were selected from the middle Taiwan in a cross sectional design. 77.6% of the patients received home care (HC), while 10.3% and 12.0% were cared in nursing homes (NH) and residential care facilities (RCF) respectively. The average months of receiving rehabilitation service were 11.69 (HC group), 14.78 (NH group) and 12.91 (RCF group). The average numbers of outpatient rehabilitation visits per year were 131, 214, and 211 for the HC, NH, and RCF groups respectively. After controlling for demographics, socioeconomic status, urbanization, health status, and medical service setting, the utilization and medical expenditure of the rehabilitation service were significantly higher in the long-term care facilities (NH and RCF groups) than in the HC groups. The RCF had highest utilization and the NH group had highest medical expenditure. The utilization and medical expenditure of the rehabilitation service were significantly higher among the disabled stroke elderly in the long-term care facilities than those cared at their homes. In order to increase the efficiency of the use of rehabilitation service, the government may apply the study findings to project the medical expenditure in designing a long-term care insurance system.