健保物理治療 vs 自費物理治療 (by 姚斯元物理治療師)
問題:什麼時候你會需要自費物理治療?
回答:當健保無法治癒你的時候。
為了回答這個問題,我們首先得知道幾件事:
1, 健保的物理治療項目有哪些?
2, 自費的物理治療項目有哪些?
3, 什麼時候建議從健保改嘗試自費?
全民健康保險(健保)的目的是什麼?
健保法規第一條:「為增進全體國民健康,辦理全民健康保險(以下稱本保險),以提供醫療服務,特制定本法。本保險為強制性之社會保險,於保險對象在保險有效期間,發生疾病、傷害、生育事故時,依本法規定給與保險給付。」
所以健保是在使人人都能得到至少最基礎的醫療服務,他不是要給你更進階、更新、效果更好的醫療服務。當你需要更好的醫療服務時,你可以選擇自費的醫療項目。但其實你也不總是需要新的、好的醫療,而是視情況選擇適合你的。
在之前的物理治療的介紹裡,有提過物理治療包含儀器治療、徒手治療和運動治療。事實上健保也包含這三種類別。
儀器治療:牽引、冷熱敷、紅外線、石蠟浴、超音波、短波、微波、向量干擾、電刺激(電療)、低能雷射、紫外線、磁場治療、循環治療、水療。
徒手治療:按摩、鬆動術。
運動治療:被動關節運動、肌力訓練、平衡訓練、等速肌力訓練、心肺功能訓練、行走訓練、姿態訓練等等。
一般來說,健保的診所大概只能做到儀器治療,因為空間和人力不足。有些醫院能夠做到徒手治療和運動治療,例如台中的澄清醫院徒手治療蠻有名的。
自費物理治療有什麼好處?
那我們來看看常見的自費項目有哪些。
儀器治療:體外震波治療、筋膜震動器、KKT聲波脊椎平衡等等。
徒手治療:更進階的徒手治療如顱薦療法、內臟按摩、激痛點療法、肌筋膜放鬆術、淋巴按摩等等
運動治療:神經肌肉再教育 (例如 Redcord 紅繩懸吊系統)、SFMA 精選功能性動作評估、神經動能療法 NKT、動作控制訓練、個人運動計畫等等。
儀器治療方面有比較明顯的規定項目,但其實健保並沒有規定徒手治療和運動治療實際上要執行哪一種,這取決於物理治療師他在健保體制下能夠花多少時間和心力在一位病人上。在大多數醫院與診所健保的治療下,一位物理治療師可能需要同時照顧多位病患,平均一位治療師可能只能花三到十五分鐘在一位病患上。要執行一些花時間的徒手與運動治療就變得比較困難。
自費物理治療下,物理治療師是以一小時為單位(有些會以半小時為單位),提供一對一的評估和治療。他會仔細聆聽你的病史、生活習慣,並且仔細為你做檢測和動作評估,了解你的肌肉、骨骼、關節的狀況,有時甚至需要瞭解你的心理狀況。
楊宛青物理治療師為競技體操選手做自費的評估與治療
經過細心的了解,在給予最適當的治療方式。但自費物理治療所的小小的麻煩的地方是,你需要先得到診斷證明或是醫囑才能進行治療。一種需要先解鎖才能打副本的概念XDDDDD
所以如果你臨時改時間或爽約,那你真的是一個XXX的病患。(好痛痛寫的,不是治療師寫的。)因為這段時間沒了就沒了,是不可能給別的病患用的。
回到一開始的問題:什麼時候該看自費的物理治療呢?
1, 當健保的治療項目無法治癒你的時候。例如你去大部分的復健科診所,在診斷後假如獲得熱敷與電療套餐,幾次後你卻沒有感到改善,那你可以考慮自費的物理治療。
這邊稍微替熱敷、電療、拉腰等等這些常被一些朋友碎念無用的治療平反一下。好痛痛之前和一些醫師與物理治療師聊的結果是「它是有效的,只是不適合每個人和每一種狀況,而且效果和操作者有關係。」
另外也可以參考凃俐雯醫師的這篇臉書文 (點此連結)。
2, 當你很清楚你想要的東西不是健保可以獲得的,而自費可以時。
例如你需要有人幫你評估運動姿勢的時候、需要全面的功能性評估的時候、或是需要一對一的個人化運動治療指導等等。
因為理想上物理治療的評估需要至少二十分鐘到半小時,全面性的評估神經、肌肉、關節、動作模式才能知道如何治療會最有效。而理想上的運動治療也是一對一的指導,而且需要至少半小時到一小時。
好痛痛希望這篇文章能讓你知道什麼時候可以選擇健保、什麼時候可以選擇自費。並且稍稍幫健保平反一下XD
其實各種醫療並沒有哪一種一定比較好,它是適不適合的問題,而非絕對優劣的問題。推薦閱讀好痛痛的另外兩篇文章:為什麼不容易找到適合的醫生、醫療是一種機率統計。
講完了健保與自費的物理治療,我們未來也會聊聊其他健保與自費的醫療,例如乾針、PRP增生注射、葡萄糖增生療法等等。
要寫的東西好多寫不完,我們希望有天可以讓人們在好痛痛的文章看一輪後,可以知道自己去看醫生時能對各種治療項目有初步的認識,不會說去了一趟醫院、診所、物理治療所之後都不知道自己在幹麻。
合作撰寫:好痛痛、姚斯元物理治療師 (ATX徒手治療研究室) (專欄連結)
協助:柔術醫師 – 林杏青醫師 (林口長庚醫院復健科總醫師)
註:本部落格文章是以科普、衛教為出發點,不代表任何人的生理狀況。每個人的身體皆不相同,有任何疑問請詢問自己的醫師、物理治療師、專業教練。
不知道你們的地址
不知道你們的地址?
如果你要找這篇的作者的話,可以用這個臉書粉絲頁跟他聯絡 https://www.facebook.com/ATXphysio/
您好,想請問小時候手斷過,但當初復健的不完全
長大後才發現自己的手臂很歪
這樣的話適合做物理治療嗎?
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