基隆市基層醫療院所參與長期照顧十年計畫2.0分析

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题名:	基隆市基層醫療院所參與長期照顧十年計畫2.0分析
作者:	林承興;Lin, Cheng-Hsing
贡献者:	高階主管企管碩士班
关键词:	長期照顧;在宅(居家)醫療;居家醫療整合照護;Loug term care;Home care medicne;Medical Home Care Integration
日期:	2018-07-05
上传时间:	2018-08-31 14:30:28 (UTC+8)
出版者:	國立中央大學
摘要:	近年來伴隨著人口結構的快速高齡化、家庭照顧功能的萎縮、失能失智人口的增加，以「生活照顧為主，醫療照護為輔」的長期照顧需求急遽增加。面對銀色海嘯的來襲，將對社會造成多方面嚴重的衝擊，長期照顧是21世紀台灣公共衛生最嚴峻的挑戰。制訂完善的長期照顧制度，也是政府必須要面對的重要健康議題，最重要的社會福利政策。行政院於2007年正式核定推動「長期照顧十年計畫1.0」，希望以「全人照顧」、「在地老化」、「多元連續服務」三大原則，建構完整的照顧體系。更於2016年9月29日公布「長期照護十年計畫2.0」，目的是要建立「優質、平價、普及」的長期照顧系統，提供國民「看得到、找得到、用得到」的長照服務。長照2.0與長照1.0最大的差異主要有三： (1) 彈性與擴大：擴大照顧服務對象；擴增服務項目；提升機構照顧的服務品質，提高被照顧者的機構安置費；提供交通接送服務，滿足民眾多元連續的照顧需求；提供主要照顧者喘息服務，減輕照顧者的「壓力負荷」。 (2) 創新與整合：試辦失智症照顧服務；原住民社區整合性服務；成立社區整合型服務中心、複合型日間服務中心與巷弄長照站。 (3) 沿伸：服務「向前」延伸，強化社區關懷據點功能，預防失能或延緩失能的健康促進服務；「往後」延伸，藉著照顧管理專員的完整評估，提供居家醫療照護、安寧居家療護。健保署於2016年公告「全民健康保險居家醫療照護整合計畫」，鼓勵醫事機構，尤其是基層診所連結社區照護網絡，對失能、失智、或因疾病特性導致外出就醫不便者，提供可近性，整合性的全人照顧。這是非常優質的前瞻設計，是以「人」為中心，以「家」為中心的醫療新思維，讓醫療和長照無縫接軌，落實「社區照顧」、「在地老化」的目標。本研究的目的在於透過對基隆地區醫療診所的問卷調查，就長期照顧計畫的認知面、實質面、政策面提出分析探討與相關的建議，期許能激發醫師服務的熱忱，民眾熱烈的響應，共同為長期照顧計畫的實施要點努力，實現禮運大同篇：老有「善」終的理想世界。;In recent years, with a fast-growing elderly population, the decline of family care, the increase of the disability and the dementia population, the demand for long-term care with "life care as the main and medical care as the supplement" has increased dramatically. Faced with the attack of the silver tsunami, it will be a serious impact on the community,the long-term care is the most serious public health challenges in Taiwan in the 21st century. To create a perfect long-term care system is also an important health issue to be faced by the Government and is the most important social welfare policy. In 2007, the Executive Yuan formally approved the" long-term Care 10-year Plan 1.0 ", hoping to construct a comprehensive care system with the three principles of" holistic care ", " ageing in the place "and" multiple continuous service ". More on Sep.29, 2016, the Executive Yuan announced the "Long-term Care 10-year plan 2.0", the aim is to create a "high-quality, affordable and accesible long-term care service model", providing the people "easy-to-find, easy-to-acess, easy-to-use". There are three main differences between the plan 2.0 and the plan 1.0: (1). Elasticity and expansion:extend coverage to more users,increase the number of service items offered, promote the service quality of the institutional care,increase the paymemt of the institutional settlement, provide the transport services to meet the people’s need of multipue continium care, provide the primary caregivers with assistive services to relieve the "pressure force load ". (2). Innovation and Integration: pilot the dementia care services,integrated services for aboriginal communities, establish the community-based integrated service center(Tier A"flagship stores" ), combined service centers(Tier B"speciality stores"), combined day-service centers, and long-term care stations(Tier C"grocery stores"). (3). Extension the Service from the front end to the back end: strengthen the function of community care, prevent or delay the disability happened by health promotion activities, provide the medical home care and the hospice care through a complete individual evaluation by the long-term care managers. In 2016, the National Health Insurance department announced the "National Health Insurance Medical Home Health Care Integration Program" to encourage medical institutions, in particular grass-roots clinics, to link community care networks to provide accessible and integrated medical home care and the holistic care to those who are not able to go out for medical reasons because of the disability、dementia or disease characteristics. This is a very high quality forward-looking design, is a new medical thinking,"people" is the center, "home" is the center. The medical care and long-term care seamless integrated, implemented the goal of "community care", " ageing in the place". The purpose of this research is to analyze the cognitive aspects, substantive aspects and policy aspects on the long-term care plan through the survey for the grass-roots clinics in Keelung area. We hope to provide the relevant recommendations in order to inspire the enthusiasm of physicians, the public enthusiastic response, and the work for the implementation of long-term care service. It is to nurture a society that values respect and compassion for its elderly members and the realization of the ceremony “Leeyun Datong” article: The old have "good" end of the ideal world.
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