歩行リハビリテーションと老人

抄録

The health care systems of many developed nations are under close scrutiny today because funding bodies, both government and insurance, are concerned about rapidly increasing costs. Some of this cost increase is, of course, due to the growing demand for services, especially accruing from a rapid escalation in the numbers of elderly persons who tend to be heavy users of health care services. A large measure of the cost increase, however, is due to the professionalisation of the health care workers who demand and receive professional salaries or fees for the work they do. For example, a decade ago an Australian physiotherapist commenced work at a salary equivalent to \1,440,000 today, a new graduate begins at \2,400,000 an in-crease of 67% in ten years. Unfortunately, there is very little evidence available at the present time to demonstrate the value, or cost effectiveness, of these health care professionals. We all believe that we are essential but it is difficult to prove it. Health economists in Australia, and in many other countries, are closely examining organisational budgets and many are using very' large shears to prune all unessential costs. Physical therapy is, sadly, one of many disciplines which is likely to have budgets reduced be-cause it has been very slow to develop objective data bases and to institute objective evaluation pro-grams to show precisely what physical therapists have contributed to the care of clients, to show precisely what the effects of that contribution have been, especially in economic terms. As a manager, a major part of my job is ensuring that the services provided by my staff are guided by strategic plans which conform to the objectives of the hospital, have clear goals, targets and performance measures, and are demonstrably effective and efficient. Thus, we work diligently and constantly at evaluation, especially examining processes and procedures to eliminate any activity which does not contribute to a planned outcome. About 70% of the clients in our rehabilitation programs: inpatient, outpatient and domiciliary, are aged 65+. We need to remind ourselves constantly that the life expectancy of an elderly person after a major episode such as a stroke or amputation is not great, 80% living less than 5 years. Thus, old people do not have time to waste in prolonged rehabilitation programs, they want to achieve a particular functional level which will allow them to go home as quickly as possible.