建構長期照護體系先導計畫: 實驗社區介入前的照護需求與自付費用

Objectives: To assess demand for services among the disabled in the community, and to provide baseline information for establishing a community care network for the disabled. Based on the current level of service utilization, this research intends to estimate the costs of medical care, formal long-term care, and family care. Methods: Data were collected in the baseline survey from two experimental communities (Chia-Yi City, and San-Yin area of Taipei County) selected for the Pilot Program for Long-Term Care Development. Eligibility for inclusion into the sample was having a disability in the activity of daily living, instrumental activity of daily living, or cognitive function. Out of the 435,000 residents in these two communities, those residents deemed eligible were interviewed face-to-face. Information regarding medical care, long term care, and family care were collected as the basis for cost estimates. Results: About one-third of respondents had been hospitalized in the past year. About 30% of respondents used emergency services. About two-thirds had had physician visits in the past month. As for long-term care, 72.1% depended solely on family members, 10.1% were institutionalized, 14.2% had hired an aid, and 6.6% used community-based care. Little alternative existed besides institutionalization and personal aid. The main determinants for institutionalization or hiring an aid were cognitive disability and ADL (5 items or more) disability. The total out-of-pocket medical expenses for the two communities over a month was about $NT 2,000,000. Seventy percent was spent on physician visits, and less than 8% on hospitalization and emergency care. The cost of long-term care was estimated at 59 million, of which 77.8% come from opportunity cost of family caregivers, 10% from institutional services, and 11.8% from personal aids. The cost estimation did not include reimbursement from National Health Insurance, the opportunity cost of a secondary caregiver, and caregiver burdens. Conclusions: Most of the long-term care is provided by family members, followed by institutionalization and personal aid. Community-based care only made up an insignificant percentage, representing a barrier before reaching the goal of "Aging in Place".