臺灣社區整合照顧的經驗與挑戰：以健康照護專業服務為例

The Experience and Challenge of Community-Based Integrated Care in Taiwan: The Example of Health Care Services

為了實踐在地老化並降低醫療與長期照護成本，以居家社區為基礎的長期照護服務整合模式，受到老化國家的重視與推廣，臺灣也積極發展整合服務，為此，本研究以剛起步的臺灣長期照顧2.0制度運作的整合服務為研究標的，採用焦點團體、深度訪談與實地觀察方法，以Reed et al.（2005）之微觀、中觀及鉅觀三種層次架構，分析當前臺灣社區整合照顧發展的經驗與挑戰，希望能提供政策發展參考。本研究主要發現如下：（1）支付制度讓競爭關係大於整合關係，建議增強整合誘因與機制；（2）欠缺品質檢核機制，應透過專業對話，建立專業的權限、角色、責任與問責；（3）個案資訊取得不易，造成整合服務的高門檻與困難度；（4）整合服務缺乏統整、協調的決策者，建議照管專員或A個管承擔此角色發揮功能。

In order to practice aging in place and reduce the cost of medical care and long-term care, the home and community-based integration model is valued and promoted by the aging countries. Taiwan is also actively developing integrated care. Hence, the purpose of this research is to observe the integration care practice under the Taiwan's long-term care 2.0 system, and provide suggestions for policy development through the practical experience analysis. This study uses focus group, depth interviews and observation research methods to collect the integrate care practice information and uses the micro, meso and macro views constructed by Reed et al. (2005) to analyze the current experience and challenges of integrated care in Taiwan. The main results of this research are:(1) The payment system makes the competition relationship greater than the integration relationship between the professional workers, and it should be recommended to enhance the integration incentives and mechanisms; (2) The system lacks a quality supervision mechanism. This system should be developed through discussion between different professional worker to clarify the different professional worker's authority, role, and responsibility; (3) It is difficult to obtain client's information, which leads to the barriers in integrated care; (4) The system lacks a decision-makers to enhance the consolidation and coordination of the integrated care. The care manager or case manager should play this role.