Graduate Institute of Injury Prevention and Control, Taipei Medical University, No, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
BMC Health Serv Res. 2013 Oct 14;13:416. doi: 10.1186/1472-6963-13-416.
Before 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person's eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system.
To develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III.
The measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability.
This study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.
在 2007 年之前，台湾的残疾评估基于医学模式。根据《残疾人权益保护法》，自 2012 年起，全国范围内的残疾津贴资格评估必须基于《国际功能、残疾和健康分类》（ICF）框架。本研究的目的是：1）设计基于 ICF/ICF-儿童和青少年的残疾资格评定系统的评定工具；2）比较新旧评定系统中残疾等级的差异；3）分析新的残疾评定系统的结果。
为了制定残疾鉴定评估工具和程序，我们成立了一个实施工作组，包括 199 名专业专家，并在第一阶段进行了小规模的现场试验，以检验评估工具的可行性。为了完善评估工具和流程，并比较新旧系统中残疾等级的差异，我们在第二阶段在全国范围内进行了一项基于人群的随机抽样研究，共招募了 7329 名残疾人。为了顺利实施新系统并了解新系统的影响，我们建立了合作机制，并从信息系统中提取了 168052 名申请残疾津贴的人员数据进行了分析。
经过多次修订，已经开发并在现场使用了身体功能/结构成分的 43 项措施、残疾评定系统活动/参与成分的功能量表以及需求评估。在第二阶段，新旧系统的残疾等级有 49.7%的一致性。在第三阶段，110667 名残疾人通过新系统获得了福利服务。其中，77%获得基本社会福利支持，89%获得经济支持，24%获得辅助技术津贴，7%获得照顾者支持，8%获得居家护理和康复服务，47%获得残疾人停车许可证。
本研究表明，基于 ICF 的残疾评估系统可以为残疾评估、需求评估和福利服务提供共同的语言。然而，所提出的评估方案和工具需要进一步的测试和验证。
