台灣地區長期照護的問題與對策

本文旨在評估目前台灣地區長期照護的問題並提出未來發展策略。我們依據長期照護系統中的五個構成要素：資源、經濟支持、組織管理、服務提供、與政策來進行評估，結果發現：(1)目前我國最迫切的問題是長期照護人力與設施的嚴重缺乏，以致不但失能老人的照護大都由其家人單獨承擔，且慢性病人長期佔用急性病床，與未立案安養中心快速成長；(2)長期照護費用幾乎全由老人或其家人負擔，而全民健保只列入慢性病床與有限的居家護理給付，並未將其它長期照護服務納入給付；(3)由於長期照護業務分屬衛生與社會福利體系，造成長期照護資源與服務提供無法有效組織與管理的困難。根據上述發現，我們建議應即設定明確政策目標，建立我國理想長期照護體系，包含：發展人力與設施，整合衛生與社會福利服務體系，籌措公共財源，鼓勵非正式服務，以提供合正可近的長期照護服務。最後，我們並建議進行深入的長期照護政策相關研究以促進政策的形成與推展，滿足老人的長期照護需要。
Institute of Public Health and Center for Health Policy Research, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC. This paper aims to critically assess the issues and suggest directions for long-term care in Taiwan according to a conceptual framework that considers the long-term care system as being composed of five interconnected components: resources, organization, financing, management and delivery. Three major problems are identified. (1) The most urgent and severe problem is the lack of long-term care manpower and facilities. As a result, most dependent elderly persons are cared for by their families without any formal supporting program, and a substantial portion of acute hospital beds are occupied by long-stay patients. In addition, the number of uncertified nursing homes with poor quality care hasbegun to increase rapidly. (2) Almost all the expenses of long-term care come from out- of-pocket payment. National Health Insurance only covers the benefits of hospital services for long-stay patients, whereas, the benefits of long-term care services are excluded. (3) It is difficult to coordinate health and social services for the elderly because they are organized through different bureaucratic systems in Taiwan. Therefore, we recommend the establishment of clear policy objectives for the development of long-term a care system, including the production of manpower and facilities, the coordination of health and social systems, the financing of long-term care services, the encouragement of informal services, and the pursuit of equitable access to long-term care. Finally, intensive long-term care policy research is recommended to facilitate policy formulation and program implementation to meet the needs of the Taiwanese dependent elderly.