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題名：人口老化與健康壽命預期對台灣長照人口數量之影響
作者：張國偉 引用關係
作者(外文)：CHANG, KUO-WEI
校院名稱：國立中正大學
系所名稱：社會福利學系暨研究所
指導教授：王德睦
學位類別：博士
出版日期：2013
主題關鍵詞：人口老化；壽命延長；失能擴張；健康預期；蘇利文法；健康促進；Aging population；Increasing life expectancy；Expansion of disability；Health Expectancy；Sullivan’s Method；Health Promotion
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摘 要
目標：健康預期是近來歐盟用於發展討論人類壽命於延長的過程中伴隨而來的兩種健康情況，即是健康壽命隨著時間上升（疾病壓縮假設）與罹病壽命隨著時間上升（即疾病擴張假設），所以可以被用來討論壽命延長的過程中之生命品質（quality）與生命數量（quantity）的變化（WHO,1984）。健康預期亦可用來觀察城鄉別、人口別、性別、族群別等健康不平等現象，可以幫助社會政策介入時的資源分配與影響評估，也可以幫助未來健康照護與長期照顧保險政策之調整參考。
資料與方法：本文以2000年與2010年『戶口及住宅普查資料』，輔以2000年、2005年與2009年之『老人生活狀況調查』之電話訪問調查資料，進行平均餘命、慢性病、日常生活功能需要協助等盛行率的分析，進一步搭配世界衛生組織所提出的死亡、疾病、失能、健康之轉換模型，討論自2000年至2010年間健康預期壽命變化與壽命變化之相對趨勢。計算方式一般採用蘇利文法（Sullivan method）計算罹病率、失能率與簡易生命表後，套用於WHO之健康狀態轉換比例模型變化圖與實際比例增減數值，是最為廣泛採用的觀察方式（Sullivan, 1971）。
研究結果：首先，2000年與2010年戶口及住宅普查資料計算結果顯示兩性皆出現『壽命延長、健康預期壽命延長、失能擴張』，其主要的原因在於壽命延長的增幅大於健康壽命延長的增幅，換句話說，就是死亡率降幅大於失能降幅，其中女性表現優於男性。其次，失能者之失能嚴重程度於這十年間的變化，出現輕度、中度大幅下降，重度失能者比例大幅上升的現象，這是相當有趣且值得後續研究進一步追蹤與調查的議題。第三，三次調查資料發現，2000年至2005年出現『壽命延長、罹病壓縮、失能擴張』；2005年至2009年出現『壽命延長、罹病擴張、失能壓縮』；2000年至2009年出現『壽命延長、罹病擴張、失能擴張』的現象，顯示短期來看我國中高齡人口之健康狀態出現動態變化，但長期來看調查資料與普查資料出現一致性的趨勢。第四，失能人口推計有兩種不同假設，（1）維持2010年普查失能盛行率不變假設，其結果顯示2012年時，65歲以上失能數，男性14萬6千165人，女性19萬1千6百26人，2020年之前兩性80歲以下失能人口比例均維持於5％以內，2030年女性開始激增接近10％，隨著人口老化越嚴重，佔人口結構比重將更高。（2）按照2000年至2010年之50歲以上年齡組失能擴張趨勢變化，假設：男性擴張從50歲起各年齡組起算依序為每隔10年出現0％、0％、0％、0％、1％、2％、5％的現象。女性方面則是每隔十年分別增加0％、0％、0％、0％、0％、0％、5％的現象，結果顯示，2012年時，男性不分齡共有38萬7千594人需長照；女性則是48萬5千70人；65歲以上男性則有14萬6千165人，佔男性總失能人數的37.71％；65歲以上女性則有48萬5千96人，佔女性總失能人數的39.50％。男性於2028年65歲以上人數即是2012年的2倍（由146,165變成292,134），女性於2026年為2012年的2倍（由191,626增為379,313）。失能人口中，65歲以上人口比例，可以看到比例上升速度更快，男性於2016年突破40％，2023年超過50％，2030年超過60％；女性則於2013年超過40％，2020年超過50％，2027年超過60％，2032年超過70％，照此擴張速度前進，我國政治、經濟、社會制度將會產生無法想像的重大影響。
政策建議：由於中高齡人口是臺灣首批嬰兒潮退休的人口群，因此，其罹病率、失能率、預期壽命是影響國家社會的健康與福利等社會政策重要關鍵，建議政府相關可以建立長期監控指標，作為以後規劃施政藍圖的重要參考依據，尤其是針對未來長期照護保險制度與全民健康保險制度的財務規劃上之參考。國際趨勢上『健康促進』與『社區發展』的結合，已是世界衛生組織推行之重點工作，我國由衛生署於1993年開始一連串的健康促進目標與服務措施介入，可惜的是健康預期指標建立卻未見，因此未來除了進一步建立健康預期測量指標外，更需長期監控我國需長照人口數量變化，與介入改善失能率，才是重要目標與方向。
ABSTRACT
Objectives: Health expectancies were first developed to address whether or not longer life is being accompanied by an increase in the time lived in good health (the compression of morbidity scenario) or in bad health (expansion of morbidity). So health expectancies divide life expectancy into life spent in different states of health, from say good to bad health. In this way they add a dimension of quality to the quantity of life lived (WHO, 1984). Health Expectancy can be further used to observe regional differences, demographic differences, gender differences, ethnic differences in health inequalities. Can also be used for social policy intervention in the allocation of resources and impact assessments can also help future health care and long-term care Insurance policy to adjust the reference.
Data and Methods: This thesis uses the general model of health transitions (WHO, 1984) shows the differences between life spent in different states health expectancy changes and gender differences in Taiwan’s elderly population (2000、2005、2009、2010): total survival, disability-free survival and survival without chronic disease. This leads naturally to life expectancy (the area under the 'mortality' curve), disability-free life expectancy (the area under the 'disability' curve) and life expectancy without chronic disease (the area under the 'morbidity' curve). Health expectancies are most often calculated by the Sullivan method (Sullivan, 1971). Disability prevalence Database Source: 2000 and 2010 "Population and Housing Census Data", supplemented in 2000, 2005 and 2009 on the "Survey of Living Conditions of the elderly" (using Computer-Assisted Telephone Interviewing, CATI). Life table database source: From 2000 to 2010, the number of deaths, the number of years. Life tables constructed to distinguish five age group, male, female, calculate Life Expectancy.
Conclusion: First, the 2000 and 2010 Population and Housing Census data calculations show that both sexes appear "Life Expectancies be improved, Health Expectancy increase the proportion of disability associated with expansion phenomenon." The main reason is that the increase in life expectancy is greater than the increase in healthy life expectancy, in other words, death rates fell more than disability decline, in which females outperformed males.
Secondly, disability severity of disability changes in this decade, showing: mild, moderate dropped significantly, the proportion of severe disability significant increase of the phenomenon. This is quite interesting and worthy of further study further tracking and investigation issues.
Third, the three surveys data analysis, found that: from 2000 to 2005 appeared "Life expectancy increased; morbidity compression; disability expansion trend." Also found that: from 2005 to 2009 appeared "Life expectancy increased; diseased expansion; disabling compression trend." Also found that: from 2000 to 2009 appeared "Life expectancy increased; diseased expansion; disability expansion trend." Results indicate that in the short term, Taiwan's elderly population health status appear dynamic change, but the long term, the survey data and census data appear consistent trend.
Fourth, Population projections has two hypotheses: Static maintain 2010 (1 - (D_nLx /T_nLx ,%)) level; dynamic expansion, keeping 2000-2010 growth rate. The results showed that: (1) in 2012, the number of disability over 65 years, the number of 146,165 men, women number 191,626. Less than 2020 years ago, Younger than 80 years of age of disability gender proportion of the population has been maintained less than 5%. In 2030, women will reach 10%. This phenomenon will be more serious with population aging, the proportion of the population structure will be higher. (2) Expansion assumptions: Male from 50 years of age, each age group starting order of 0%, 0%, 0%, 0%, 1%, 2%, 5% increase; women are 0%, 0% , 0%, 0%, 0%, 0%, 5% increase.
In 2012, there are 387,594 men need long-term care; has 485,070 people are female. In particular, the 65-year-old male who has 146,165, accounting for 37.71% of the total number of males. There are 485,096 people are women, accounting for 39.50% of total female. In 2028, men over 65 are two times in 2012 (from 146,165 becomes 192,134); in 2026, women are two times in 2012 (by a 191,626 increase to 379,313). Over 65 years the proportion of disabled population increased faster. Men in 2016 exceeded 40%, in 2023 over 50% in 2030 over 60%. Women have more than 40% in 2013, in 2020 more than 50%, in 2027 over 60% in 2032 over 70%. According to the rate of expansion ahead, Taiwan's political, economic and social systems will produce unpredictable significant influence.
Policy Suggestion: Taiwan will encounter baby boomers retire. Therefore, morbidity, disability, life expectancy is the impact of national social health and welfare of the key social policy. This thesis suggests that the Government must establish long-term monitoring indicators as an important reference for future planning policy basis. Especially for future long-term care insurance system and universal health insurance system's financial planning reference. Currently, the "health promotion programs" and "community care" is the important work of the World Health Organization. Taiwan's Department of Health began in 1993 a series of health promotion goals and service measures to intervene. Unfortunately, there is no clear information on health expectations. Therefore, the future in addition to further establish healthy measure, the more need for long-term monitoring of the work, to see the need to change the number of long-term care population, and further intervention to improve the rate of energy loss, is an important goal and direction.
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