醫療機構長照復能事業之經營與發展策略分析-以臺大醫院北護分院為例

Abstract

隨著人口老化以及失能人口增加，如何以有限資源有效率地提供長期照護為國家當前迫切面對的問題。政府於2017年接續長照十年計畫(2008-2017，簡稱長照1.0)提出了長照十年計畫2.0(簡稱長照2.0)，預計在2026年前能將長照服務完整的輸送給有需求的國民。和長照1.0相比，長照2.0新增了一項「復能計畫(reablement)」，規劃由居家復健治療人員，針對患者居家活動不足的部分設計居家治療計畫，以期增進日常生活功能。然而，醫事機構對長照業務不熟悉、不敢涉入不確定性高的計畫性業務，導致實施之初發生醫事機構裹足不前、患者無法得到足量醫療照護的困境。 本研究嘗試系統回顧復能服務的文獻，提出合適臺灣的操作模式；並以五力分析剖析產業特性。進一步分析醫事機構的定位、優勢及劣勢，以提出參加復能服務的策略。希望能創造服務提供者(醫事機構)、顧客(患者)、及政府三方皆贏的照護模式。在文獻的系統回顧上，以「reablement」、「home care」、「home rehabilitation」、「tele-rehabilitation」等關鍵字於MEDLINE資料庫中進行系統化搜尋、整理；並從高齡化、政策面、與醫療體系的銜接、人力招募、財務因素等總體環境面向剖析；以期提出適合臺灣文化與規模的復能服務模式。在醫事機構的定位與策略上，針對私立醫學中心、私立區域醫院、公立地區醫院、以及診所復能業務負責人進行問卷深度訪談。問卷內容涵蓋組織架構、人力資源與獎酬制度、競爭策略等面向，了解負責人對復能計畫的認知、態度、與困難，並據此分析醫事機構加入復能計畫採用之策略。 本研究發現復能服務的產業關鍵因素為：專業人力、完整產品線、口碑、與一致的企業核心價值。北護分院具有上述關鍵要素之優勢，然亦有人力招募不易，組織架構缺乏彈性等劣勢。考量臺大醫療體系對國家政策執行負有使命，北護分院執行復能服務責無旁貸。未來應以「擴大A單位、示範B單位、精緻C單位」為發展策略。在訪談同時發現目前施行復能面臨之問題包括：執行人員與家屬對復能目標不盡熟悉、復能與其他補助或復健重複造成浪費、對接受服務個案之成效缺乏客觀評估量表以提供實證。未來應以加強長照復能宣導及教育、整合社福資源以避免資源重複浪費發生、以具實證之量表進行復能成效評估、研發科技輔助長期照顧。

It is a great task to provide long term care service to the elderly and the disable in an aged society like Taiwan. The Taiwan Government started the National Ten-year Long-term Care Plan (LTC 1.0) since 2008, and launched National Ten-year Long-term Care Plan 2.0 (LTC 2.0) since 2017. Compared with LTC 1.0, the LTC 2.0 has a special home rehabilitation program—reablement, which is emphasized by enhancing the activities of daily living, and provided by home therapist. However, due to unfamiliarity to reablement and uncertainty of new policy, the supply of reablement from medical institution is not adequate. This thesis reviewed literature of reablement service, and suggested the appropriate model in Taiwan. It also analyzed the characteristics of industry by Five-Force Analysis, and delineated the strength, weakness, opportunity, and threat of National Taiwan University Hospital Beihu Branch (BH Branch). The goal of this thesis is to find the suitable strategy to create a win-win-win situation for the government, the hospital, and the clients. We used ‘reablement’, ‘home care’, ‘home rehabilitation’, and ‘tele-rehabilitation’ as the key words to search Medline. The reablement industry was analyzed the five aspect of macro-environment, that is ageing demography, policy, connection with medical system, personnel recruitment, and finance. The strategy of competitors, including medical center, regional hospital, district hospital, and clinic, was collected through in-depth questionnaire covering organization, manpower and compensation, and competitive strategy. This provided the attitude, cognition, and vision of responders in the institutions providing reablement service. The thesis found that the industry key elements are professional personnel, complete product line, word of mouth, and consistent core-value. The BH Branch has the key elements as strength, yet, rigidity of organization and difficulty in recruiting new professionals as the weakness. Since the NTUH system is responsible for the implementation of health-related policy, the BH Branch should execute the Reablement Program. In the future, the BH Branch should aim to ‘expand A unit, demonstrate B unit, and delicate C unit’. The LTC 2.0 is facing the problems of (1) the clients and professionals are not familiar with reablement service, (2) the reablement is redundant with some other subsidies, (3) no objective questionnaire for the outcome evaluation. We suggested that the government should strengthen reablement propagation and education, integrate all subsidies from government, validate the efficacy of reablement by objective questionnaires, and develop new assistive devices.