近年來老年人口數增加，疾病型態慢性化，使長期照護在今日的醫療體系上佔有重要的地位。長期照護的服務型態眾多且複雜，而今健保對長期照護病患的給付使得各醫院無法提供一個完整的醫療服務，故導致慢性病人久佔急性病床，造成各醫院相當大的衝擊。本研究從各級醫院著手，瞭解健保實施後長期照護病患對各醫院所產生的衝擊以及醫院對健保局或衛生署的建議。結果顯示：長期照護的設置以醫學中心和公立醫院為主，在70家有提供長期照護服務的醫院中，有61%的醫院認為健保實施後長期照護病患的確帶給他們衝擊，39%的醫院認為沒有。而衝擊的項目中以慢性病患住院日延長最多，其次是呼吸器的使用耗費人力、慢性床的給付遭核減。這些衝擊亦有促成一些醫院成立居家照護和日間留院以紓解病床的壓力。故建議各醫院做好住院前審查和完善的出院計畫，並為慢性病患建立後送醫療服務系統如：護理之家和轉介，如此亦能維持良好的醫病關係。 Because the increase ofof elderly populatlon and chronic diseases, long-term care plays a very Important role In the medlcal system. Due to IU Its compllcated.ed and numerous service types, long-term dellvery service can't offer a comprehensive services under the current health insurance payment system. The occupatpancy rate of acute beds for chronic patients in hospital is quite high, this results in nehegative impact on most of hospitals. Results showed that: long-term care facilities in hospitals were almost afflllated with medical centers, public hospitals. 61% hospitals got Impacts under the NHIP. Negatlve impacts included delay of length of stay(LOS) for chronlc patients, need of more luman resources for oxygenator users and cuttlng of relmbursement for chronlc beds. These mpacts also urged hospital manager to establish home care and day care center for releasing high occupancy rate of beds by chronic patlents. We recommend that the hospital manager should improve audit of pre-admission and comprehensive plan of discharging patients. It is s also important to establish a better post-discharge system for chronlc patlents, such as nurslng home and transfer system for keeping a better relatlonship between physicians and patients.
