監獄醫療之現況調查及需求評估(1/3)

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Title:	監獄醫療之現況調查及需求評估(1/3)
Other Titles:	Health Care Needs Assessment in Prison
Authors:	蔡文正(Tsai,Wen-Chen);林正介(Lin,Cheng-Chieh);許南榮(Hsu,Nan-Yung);龔佩珍(Kung, Pei-Tseng);張伍隆;李奇學
Contributors:	公共衛生學院醫務管理學系
Keywords:	監獄醫療;收容人;醫療需求;Health care in Prison;health care;Health care needs
Date:	2004-12-31
Issue Date:	2009-09-01 15:08:38 (UTC+8)
Abstract:	全民健康保險於民國84年實施以來，迄今已將屆滿10年，其主要目的便是希望能消除民眾就醫時的經濟障礙，達到保障全體國民身心健康之目的。然而在健保實施之初，全民健康保險法第11條將軍人與收容人(包括在監、所接受服刑之執行或接受保安處分、管訓處分之執行者，後統稱「收容人」)排除在外。民國90年業已將軍人加入全民健康保險之保險對象，至今惟獨將在監、所服刑之收容人排除在健保的保護傘之外。監所的收容人背景複雜，收容人當中約有百分之四十五以上為吸食或施打毒品者，其所造成的戒斷現象與種種的後遺症，全部在羈押或執行中顯現出來，再經長期的禁錮所產生的心理偏差、反抗、鬱卒、敵視及反社會情緒更是表露無遺。然而多數收容人刑期有限，終究有一日會回歸於社會，倘若收容人於獄中未受到適當之醫療照護，在其出獄回歸於社會以後，仍然會造成社會與健保的負擔。矯正司為了改善監、所收容人醫療上的障礙，改善監所醫療設施，提昇診治服務品質，旋即擴大與台灣各地公私立醫院及私人診所、國軍醫院、宗教團體醫院簽約設立專屬病房以及延聘醫師實施診療，甚至未來成立台灣北、中、南區專業醫療監獄等，目前已於91年4月在台中成立監獄醫療專區，同時臺中監獄預計於92年10月與中國醫藥大學附設醫院合作，試辦監獄醫院，提供門診、住院、甚至手術等醫療照護，希望藉此使收容人也能得到較佳的醫療品質，並可減少收容人戒護就醫所產生的風險。然國內並沒有太多關於收容人的醫療或健康需求的報告，也就是說這一群人，長久以來皆被忽略了他們的健康與醫療人權。因此本研究主要希望針對全國五萬多名收容人進行問卷調查，了解監獄醫療之現況以及收容人的健康醫療需求，其次利用台中監獄設立醫療專區之看診資料，分析收容人醫療利用的實際情形並評估監獄醫院的經營成效，最後再次利用問卷，調查收容人及其家屬加入全民健保之意願與能力，透過專家座談，研擬收容人加入健保的可行性與其支付制度。希望提供健保局與衛生政策決策者方案實施的初步參考依據，以期能保障台灣地區依收容人就醫之權利，並彰顯政府對於人權保護之努力。 The major purpose of Taiwan implementing the National Health Insurance was to reduce the financial barrier to access medical care. However, the prisoners and militaries were excluded from the NHI at the beginning. In 2001 the militaries have been included in the NHI program, but the prisoners are still not the insured of the NHI program. Many prisoners would have mental diseases or other health problems after being in prison for a long time. Especially, above 45 percent of the prisoners were the drug users, who would have serious drug sequelae or complication. Most of the prisoners will return the communities after the expiration of the term sentences. So, if the prisoners did not have adequate health care services to meet their health needs, they will spend a lot of health care expenditures paid by the NHI in the future. Taiwan government attempted to improve the health care services of the prisons and installed the clinics in the prisons, which were contracted with public or private hospitals. In 2002, government has contracted with China Medical University Hospital to establish the first prison hospital in the central Taiwan. In the future, the government would like to establish more prison hospitals in jails. The prison hospitals will provide outpatient and inpatient services for the prisoners, and decrease the insufficient supply of health care as well as will improve the health care quality for the prisoners. This study includes three parts of researches. First, we will investigate the medical care supply and the demand of health care for all prisoners. Secondly, we will evaluate the operation effectiveness of the first prison hospital and analyze the health care utilization in the first prison hospital. Finally, this study will evaluate the feasibility of the prisoners？H？H health care covered by NHI. The results will provide Taiwan government for health policy decision for the prisons in the future.
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