장애인 건강주치의 제도 방문재활서비스 도입 방안

Abstract

The “Pilot Project for Primary Care for People with Disabilities,” implemented since May of 2018, provides comprehensive evaluation, plan establishment along with not only education and consultation but also service visits by doctors and nurses in hopes of enhancing necessary medical service accessibility for disabled people. However, due to the absence of visiting rehabilitation services, essential for displaced people, demands to include such measures have been consistently present. In response to this, the government included the provision of visiting rehabilitation services for disabled people as the national task. It is necessary to develop a certain model and monitoring/evaluation indicators according to the target patient’s characteristics and needs after identifying one’s need for visiting rehabilitation services. This research identified the ongoing situation of visiting rehabilitation services through analyzing domestic and international status research, claim data, and actual surveys concerning the status quo of people with disabilities. Moreover, by taking into consideration the related expert and stakeholders’ opinions, the study proposes a method to implement such a service. Looking over the domestic and international cases, the difficulty of applying specific medical standards to visiting rehabilitation services for patients in need of chronic rehabilitation sheds light on the need for consideration from diverse perspectives. The pilot project can be characterized by the fact that general health care claims provided by clinics account for 80% of the total, and doctor visit is higher than those of nurses, which explains the high availability of doctor-centered services. When providing visiting rehabilitation service to the disabled, if the primary care physician determines that the disabled person with mobility impairment necessitates rehabilitation, the service must be provided. Moreover, concerning the specialty of rehabilitation treatment, the service model was dualized according to the expertise area of the physician. For the sake of project efficiency, the study reviewed the formation of a visiting medical multidisciplinary team, the diversification of education and consulting subjects, and the cost adjustment standards that cover various situations that might occur during the visit. Lastly, monitoring and evaluation indicators were suggested to understand the effectiveness of the pilot project and patient conditions for service providers. Based on the study results, we hope that the visiting rehabilitation service will be well established in the direction of the Pilot Project for Primary Care for People with Disabilities, gradually expanding medical accessibility for disabled patients.