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Rehabilitation Practice and Science

Translated Title

全民健保制度與復健醫療發展－以台灣中區為例看復健醫療資源分佈及其未來走向

Abstract

The objective of this study is to determine the distribution of medical resources for rehabilitation in the central Taiwan area (including three counties and one provincial city) and foresee the possible influence of National Health Insurance policy on rehabilitation medicine.The subjects of this study were sixty-two hospitals or clinics in the central Taiwan area that instituted rehabilitation outpatient and/or inpatient medical services in June of 1995. Among them, four provided comprehensive rehabilitation medical services for inpatients as well as outpatients; nine had outpatient physical, occupational, and/or speech therapy departments; twelve employed full-time physiatrists but provided physical therapy only; seventeen employed part-time physiatrists and only provided physical therapy; and remaining twenty provided physical therapy supervised by non-physiatrists. The total amount of rehabilitation medical charges declared by these hospitals or clinics in June 1995 was NT$51,573,930. Hospitalization charges totaled NT$6,410,000 (12.4%); medical charges of outpatients with major disability were NT$8,153,067 (15.8%); charges for physical therapy under supervision of full-time physiatrists for outpatients with musculoskeletal diseases were NT$24,030,589 (46.6%); charges for physical therapy under supervision of part-time physiatrists for outpatients mainly with musculoskeletal diseases were NT$7,778,812 (15.1%); and, finally, total charges for physical therapy supervised by non-physiatrists for outpatients with musculoskeletal diseases were NT$5,184,462 (10.1%). Physical therapy charges account for 89.9% of the total cost of rehabilitation therapy, occupational therapy for 9.4% and speech therapy for 0.8%, respectively. On average, these hospitals or clinics received approximately NT$140,000 per month from the Bureau of National Health Insurance for medical charges in outpatient medical services for each active therapist. The figure could be as high as NT$300,000 per therapist per month in five of these hospitals or clinics. On the contrary, the Bureau of National Health Insurance only paid NT$1,833 per day for each inpatient receiving comprehensive medical rehabilitation. This shows that the difference of investment returns rates for different kinds of rehabilitative treatment is tremendous and, therefore, can worsen the disproportionate development of rehabilitation medicine and physical medicine. Suggested ways to cope with the situation include: (1) revising the payment standards for rehabilitative medical services in the National Health Insurance system to avoid the disproportional development of different sub-specialties in rehabilitation medicine; (2) increasing the amount of payments to inpatients and those with major disability to avoid the shrinkage of the market of rehabilitation medicine for major disability; (3) reimbursing as well as encouraging hospitals to hold rehabilitation wards, and setting a ratio of rehabilitation beds to beds for general patients in order to increase opportunities for patients with major disability to receive rehabilitative medical treatment as soon as possible.

Language

Traditional Chinese

First Page

65

Last Page

72

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