醫藥的進步、經濟水準的提升及生活形態的改變，使得國民平均餘命延長。1971年台灣地區65歲以上人口佔總人口數2.9％，至1993年底已達7％，步入世界衛生組織所謂的「高齡化社會」。2006年更達到9.9％，老化指數也達53.34％，預估2016年將達到13％。在短短的二十三年間，老年人口成長了約2倍，其成長速度之快，在先進國家中僅次於日本。由於我國高齡化進展快速，造成沉重的老年經濟照顧、醫療照護及其他社會負擔，未來面臨長期照護老人的多重需求、醫療照護、長期照護與全民健康保險的銜接，必須予以正視。
本研究旨在探討台灣地區長期照護機構老人與全國老人在健保醫療給付中門診、住院之相關就診疾病別、醫療服務費用之醫療利用差異，及影響長期照護機構老人之全民健保利用程度差異重要因素，藉此釐清有那些疾病或醫療行為是屬於長期照護機構老人較常見的，並製作長期照護機構老人與全國老人常見急慢性疾病別臨界服務光譜，以利瞭解長期照護與全民健康保險的臨界服務，提供訂定有關長期照護政策時必要的參考。
實證分析資料採取台灣長期照護專業協會對各類長期照護服務機構之分類方式，調查各類長期照護機構及榮民醫院護理之家2002年入住之12,460人老人資料，以回溯其至1999年的醫療利用。另為瞭解長期照護老人疾病的長期趨勢，再蒐集機構中2003年23,775人及2004年15,342人的基本老人資料，總共51,577人之機構老人資料，經身分證檢查及除錯後鍵檔，以中央健康保險局保險對象就醫之門診及住院醫療費用清單明細檔做為資料來源，擷取其醫療利用情形；並分析2004年全民健康保險醫療統計年報中65歲以上保險對象之全國老人統計資料，進行統計分析，以資比較長期照護機構老人與全國老人醫療利用之差異。除以上實證資料之分析方法，本研究輔以焦點團體專家座談方式，界定得知1999～2004年長期照護老人及全國老人所發生最常見的急慢性疾病類別，進而製作出本研究之疾病臨界服務光譜。
本研究重要發現有：一、長期照護機構老人於門診所花費的醫療費用皆比全國老人來得高，長期照護機構老人於住院所花費的醫療費用亦比全國老人來得高。二、就長期照護機構老人及全國老人醫療利用疾病類別醫療費用佔總醫療費用大於0.5%之分佈情形觀之，急性疾病類別有8類，而慢性疾病則有32類，其中慢性肝病及肝硬化、結核病、肝及肝內膽管惡性腫瘤等3類疾病，各在全國老人慢性病的排序前30項，但在長照老人慢性病的排序則為30項之後。三、針對長期照護機構老人及全國老人醫療利用門診及住院部分以罹病率為考量，而醫療總費用則以占率為考量，經假設作法做為篩選之基礎，得知1999～2004年全國老人及長期照護老人所發生最常見的疾病，進而製作出以疾病平均門診總件次、平均住院總人次及平均醫療總費用之臨界服務光譜6種。
依據上述主要發現之意涵，本研究建議一、衛生福利行政主管機關因長期照護機構老人所花費的醫療費用高，部分負擔自負額多，對此一族群宜建立補助制度。二、長期照護與社會福利之臨界服務所需大量弁鄐w養照護人力，藉由志工或其他非營利組織提供協助，宜早日規劃長期照護服務輸送制度。三、老人健康照護的相關研究應將醫療照護的完整分析結合弁鄔宒晙d資料合併分析討論。四、 本研究已創制我國長期照護體系與全民健康保險之臨界服務，藉此明白顯現長期照護機構老人與全國老人之急性、亞急性、慢性疾病與長期照護之醫療照護臨界服務範圍，未來之研究可陸續進行以疾病別為單元之臨界服務分析研究，以界定長期照護與醫療照護體系之銜接。
目前全民健康保險資源的主要耗用者為65歲以上之老年族群，而長期照護機構老人所花費的醫療費用亦比全國老人來得高，在健保財政嚴重匱乏之際，老人健康照護體系宜再探討不要使用花費高、無療效的過渡醫療化，而是給於有尊嚴與生活品質的老人弁鄐A當醫療，本研究礙於資料之限制，僅初探醫療利用情況，無法討論弁鄐暋D。

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.