Analysis of the Impact of the US and Taiwan PACE Programs on Elderly Care Services

[[abstract]]背景: 臺灣目前大約55萬高齡且需要照顧之失能人口，該如何銜接健保與長照的照顧品質與可近性，以及如何健康老化，已成為高齡化社會待解決議題。美國PACE，係一種全包式老人長期照護計畫，由一個科際整合團隊，評估虛弱老人需要，擬訂計畫，預收固定期間定額給付，來管理與提供整合且連續性的長期支持與服務，給仍失能且需技術性護理的老人。 目的: 利用文獻分析與臺灣PACE試辦計畫做綜合性的比較，以分析比較PACE計畫提供長者照顧服務的影響。 方法: 收集2003至2019年美國相關文獻，利用關鍵字收集相關學術期刊，文獻時間搜尋至2019年止，探討美國實行PACE的相關資料，同時以本文作者指導教授在102年衛福部南投署立醫院實驗的試辦計畫為基礎，整理28位參與長者在PACE照顧服務模式資料，針對美國與臺灣PACE計畫提供長者服務的各面向做文獻分析及歸納比較。 結果: 臺灣PACE試辦計畫問卷顯示個案對醫師定期訪視滿意度及需求度都非常高（88.2%~ 90.9%），美國文獻中也顯示相同結果；專人協助申請住院及門診掛號部分，在臺美的問卷及文獻中也都顯示滿意度及需求度極高（81.8%~82.4%）；照顧品質方面，臺灣問卷中顯示住院後回家的個案有35.3%認為加入計畫後改善很多，部分少數的個案及家屬甚至覺得在心理及生理方面是有改善的，美國的文獻則顯示加入PACE個案可以減少急診及住院率，提升日常生活功能，支持他們繼續跟鄰居們在社區中生活，個案家屬同時也減輕照顧壓力，提升了生活品質；參與者醫療照護自付額方面，美國PACE參與者須繳納醫療補助及醫療保險的每月自付額保費(約臺幣4000~20000元)與臺灣PACE每月平均門住診總醫療費用(約臺幣3160~10796元)是相近的；加入或退出原因，雖然國家文化及醫療政策不同，但美國與臺灣PACE的民眾想法大致相同。 結論: 臺灣與美國PACE提供長者照顧服務的影響是正面與有所期待的。 Background Taiwans current 550,000-year-old disabled population needs care. How to link health care and long-term care quality and accessibility, and how to age healthily has become an issue for the aging society. PACE, an all-inclusive long-term care program for the elderly, consists of an interdisciplinary team that assesses the needs of the frail elderly, develops plans, and receives fixed-term fixed payments in advance to manage and provide integrated and continuous long-term support and services. Give elderly people who are still disabled and need technical care. Purpos Use literature analysis to make a comprehensive comparison with the Taiwan PACE pilot project to analyze and compare the impact of the PACE program to provide elderly care services. Method Collect relevant American literature from 2003 to 2019, use keywords to collect relevant academic journals, and search the literature until 2019 to discuss the relevant information on PACE in the United States. At the same time, the author of this article is the author of the experiment in the 102nd year of the Nanfu Office of Weifu Department. Based on the pilot project, we compiled 28 information on the PACE care service model for the elderly, and conducted literature analysis and comparison of the various aspects of the US and Taiwan PACE programs. Result The Taiwan PACE Pilot Program Questionnaire shows that the patients regular visit satisfaction and demand are very high (88.2%~90.9%), and the same results are shown in the US literature; the special person assists in applying for the hospitalization and outpatient registration part in Taimei. Both the questionnaire and the literature also showed that the satisfaction and demand were extremely high (81.8%~82.4%). In terms of quality of care, the Taiwan questionnaire showed that 35.3% of the patients who went home after hospitalization thought that they had improved a lot after joining the program, and some of them were small. Cases and family members even felt that they were psychologically and physically improved. The US literature showed that joining PACE cases can reduce the rate of emergency and hospitalization, improve the functions of daily life, and support them to continue to live in the community with their neighbors. Relieve the pressure of care and improve the quality of life; in terms of the participants medical care deductible, the US PACE participants are required to pay the monthly deductible for medical assistance and medical insurance (about NT$4,000~20,000) and Taiwan PACE monthly. The average outpatient medical expenses (about NT$3160~10796) are similar; the reasons for joining or withdrawing, although the national culture and medical policies are different, United States and Taiwan PACE people think about the same. Conclusion The impact of PACEs provision of elderly care services in Taiwan and the United States is positive and expectant