A Study on the Utilization of Medical Care Services by the Elderly in Long-Term Care Institutions in Taiwan-----Defining Borderline Medical Care Services for the Elderly in the Long-Term Care and National Health Insurance

• Main Authors: Szu-Hai Lin, 林四海
• Other Authors: wh chia
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/66309275993330679193

博士 === 國立中正大學 === 社會福利所 === 94 === Advancement in medical sciences, improvement in economic conditions and changes in lifestyles, all have contributed to the prolongation of life expectancy. In 1971 in the Taiwan Area, the population above the age of 65 years accounted for 2.9% of the total population; the percentage reached 7% at the end of 1993, meeting the criteria of the “aged society” defined by the World Health Organization. This percentage reached 9.9% in 2006, and the aging index was already as high as 53.34%. It is estimated that the elderly would account for 13% of the total population by the year 2017. In the last 23 years, the elderly population has grown by 2 times. This rapid growth rate of the elderly population is next only to Japan in all developed countries. This rapid process of population aging has brought about heavy burdens in the financial and medical care of the elderly, and also other social burdens. The multiple needs in the coming future for the medical care, long-term care and their linkage with the National Health Insurance for the elderly under long-term care should be faced. The purpose of the present study is to investigate preliminarily, as reflected by the medical payment data of the National Health Insurance, the differences between the elderly under long-term institution care and the elderly of the general population in the diseases seen at outpatient clinics and under hospital care, their differences in the utilization of medical care services as shown by the medical costs, and also the main factors that affect the utilization of the National Health Insurance by the elderly under long-term institution care. Through this process, it is expected to understand what diseases or medical behaviors are common to the elderly under long-term care, and thus to develop a common acute/chronic disease-specific spectrum of borderline medical care services for the elderly under long-term institution care and the elderly of the general population to help understand what the borderline medical care services are for the two elderly groups for the reference in the formulation of policies relevant to long-term care. Data for analysis are taken from the categorization of the various long-term care institutions developed by the ROC Long-Term Care Association. Information for the 12,460 elderly cared at various long-term care institutions and nursing homes of the veterans’ hospitals in 2002 was collected; their utilization of medical care services was traced back to 1999. In addition, to understand the long-term trend of diseases of the elderly under long-term care, basic information of the 23,775 elderly in 2003 and 15,342 in 2004, totaling 51,577, cared in institutions was collected. The information was verified by ID card and keyed in computers. Medical costs for outpatient care and hospital care of those covered by the National Health Insurance were used as the sources of information. Their utilization of medical care services was retrieved. Data of the elderly 65 and above in the general population covered by the National Health Insurance in the 2004 National Health Insurance statistical report was further analyzed to compare the differences in the utilization of medical care services by the elderly under long-term care and the elderly of the general population. In addition to the analyses mentioned above, a focal group discussion method was also used. Through this process, the most common acute and chronic diseases of the elderly under long-term care and the elderly of the general population for 1999-2004 were identified, and a spectrum for the borderline medical care services of diseases has been developed. The study showed that, 1) the medical costs for outpatient care of the elderly under long-term care were higher than those of the elderly of the general population; their medical costs for inpatient care were also higher; 2) by diseases of the elderly under long-term care and the elderly of the general population, eight were acute diseases, and 32 were chronic diseases; of them, three diseases, chronic liver diseases, cirrhosis of liver, tuberculosis, malignant neoplasms of liver and intrahepatic bile duct, were, in the elderly of the general population group, ranked within the leading 30 chronic diseases; they were listed beyond the 30 leading diseases for the elderly under institution care; 3) by morbidity in outpatient and inpatient care and medical costs as percent of total medical costs, and through the use of hypothetical method as a basis for screening, diseases common to the general elderly and the elderly under long-term care for 1999-2004 were identified. A spectrum for the borderline medical care services by the average number of outpatient visits per disease, the average person-times of hospital care, and the average medical costs was developed. By these findings, the present study recommends that, 1) the competent health and welfare authorities should, by the fact that the medical costs and co-payments borne by the elderly under long-term institution care are high, develop a subsidy system for this elderly group; 2) currently, the large manpower required for the borderline medical care services for long-term care and social welfare has been provided by volunteers or other non-profit making organizations, a long-term care delivery systems should be established earlier; 3) research related to the healthcare of the elderly should integrate analysis of medical care with studies of functional surveys. At present, the largest consumers of the National Health Insurance resources are the elderly above 65; and the medical costs of the elderly under long-term institution care are higher than those of the elderly of the general population. At a time the National Health Insurance is facing financial difficulties, the use of high-cost, low-effective transitional medical care in the health care system of the elderly should be considered with care. Instead, perhaps adequate medical care of dignity and high quality of life should be provided. This study, for limitation of data, made only a preliminary investigation of the utilization of medical care services by the elderly, further studies are needed to address to issues related to functions.