Implementing disability evaluation and welfare services based on the framework of the international classification of functioning, disability and health: experiences in Taiwan
1 Ministry of Health and Welfare, No. 36, Tacheng Street, Datong District, Taipei City 10341, Taiwan
2 Graduate Institute of Injury Prevention and Control, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei 11031, Taiwan
3 Department of Public Health, Tzu Chi University, Hualien, No. 701, Sec. 3, Jhongyang Road, Hualien City 97004, Taiwan
4 Chinese Association of Early Intervention, Profession for Children with Developmental Delays, No. 63, Kuofu Street, Hualien City 97004, Taiwan
5 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3rd floor, No 17, Hsuzhou Road, Taipei 10055, Taiwan
6 Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, NO. 111, Section 3, Hsing-Long Road, Taipei 11696, Taiwan
7 Department of Information Management, National Chung Cheng University, No. 168, Sec. 1, University Road, Min-Hsiung Township, Chia-yi County 62102, Taiwan
8 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, No. 1, Changde Street, Zhongzheng District, Taipei City 10048, Taiwan
9 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan
BMC Health Services Research 2013, 13:416 doi:10.1186/1472-6963-13-416Published: 14 October 2013
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.