The Study On Policy System Framework Of Rehabilitation Services For The Disabled In Shanghai

With the further development of socio-economic, concern for the disabled will become highlighted. Funding for the disabled will also increase, but it is limited, after all. China's huge population is the basic national condition. We are facing the population and health problems of the ultra-large-scale society, facing the needs of more than 8000 million disabled. We need a "comprehensive, coordinated and sustainable development" rehabilitation policy framework to base on in order to invest limited funds to the projects that the disabled really need, to make sure the services are well supplied, to "do a good thing well". So that we can guarantee the services for the disabled are conducted in the right direction, and achieve sustainable development.Aims: To know current situation of demand and utilization of rehabilitation services for the disabled in Shanghai; to know current rehabilitation projects for all types of disabilities, to discuss if the rehabilitation projects are reasonable and if there is any new project can be expanded; to make a list of rehabilitation services for all types of disabilities and all different age groups; to know the support system for implementation of various projects; to develop policy framework of rehabilitation services for all types of disabilities.Methods: We summarize current rehabilitation services for all types of disabilities and relevant information domestic and abroad by summing up Policy documents and literature, based on which we can make the list of rehabilitation services for the disabled in Shanghai. We get to know current situation of demand and utilization of rehabilitation services for the disabled of five categories in Shanghai by investigation, and we get to know the potential needs of the disabled as well. We adopt brain storm method to determine the frame of the list and to discuss, amend, and add the list of rehabilitation service projects. We carry out expert appraisal method twice to determine current projects and future expandable projects and rehabilitation service providers, funding methods of payment, and the priority of the projects. Finally we develop the policy framework for rehabilitation for the disabled with the guidance of systematic theory, goal-gap model, and 'target population—rehabilitation project—government support system' three-dimensional model.Results:1. Government pays more and more attention on rehabilitation of the disabled. However, rehabilitation policy is not systematic; rehabilitation contents are spread and isolated; it is not realized that rehabilitation should be arranged according to the different age group; definition of the support system is ignored during the process of making policy. Thus, it is quite important to build appropriate policy framework in order to guide the following policy making and executing.2. The surveillance of satisfaction to the rehabilitation shows that 57.03% subjects feel satisfied, and 4.11% subjects think it could be improved a lot. The patients of hearing disability are more those of other kinds of disabilities among the negative subjects. It indicates that the rehabilitation for adult patients with congenital deafness is not well executed.3. The result of demand and utilization of rehabilitation shows that there is great difference among five categories of disabilities. It is implied that rehabilitation services for different kind of disabilities and age groups should be carried out step by step.4. The result of rehabilitation service providers and funding methods of payment shows that the role of family in the funding methods of payment is not concerned enough. The cost of the rehabilitation of the disabled is mostly completely or partly covered by government, the proportion of full own expense is relatively small. This result is consistent with the demonstration. However, there is no allowance for the autistic children from the government, and the private institutions are quite expensive. These factors make rehabilitation for the autistic become quite a problem.5. Surveillance of potential needs of the disabled shows that 24.69% of the subjects need help in finding jobs, 11.75% of the subjects need more allowance, 6.99% of the subjects need more entertainment and activities.6. The list of rehabilitation service is made according to literatures, policy documents, expert consulting, and investigation of potential needs. 57 projects for visual disability, 47 for hearing disability, 58 for physical disability, 37 for intellectual disability, and 35 for mental disorder are included in the list.7. By comparing the proportion of current projects, we find that the proportion of visual disability, is 42.11%, the proportion of hearing disability is 48.94%, the proportion of physical disability is 68.97%, the proportion of intellectual disability is 35.14%, the proportion of mental disorder is 65.71%. The result indicates that there are much more to expand for those with intellectual disability, visual disability, and hearing disability.8. By analyzing the support system of the expandable projects, we find that these projects are mainly supposed to be supported by community hospitals and other community agencies. Therefore we shall further strengthen the construction of these community institutions, so that the needs of the disabled could be more likely to be satisfied. The funding methods of payment are supposed to be partly covered by government. To reduce the burden of the government, some other fund by insurance could be appropriately introduced.9. The result of the priority of expandable projects shows that the community-based projects focusing on disabled children are of the highest priority, followed by settling and attending elderly persons with disabilities. Occupational rehabilitation is not of so high priority. Meanwhile, psychological rehabilitation is not fully paid attention to, which is consistent with the result of investigation of needs.10. The aim of 'target population—rehabilitation project—government support system' three dimensional theoretical model is to make sure that all the disabled within this framework are provided with the corresponded rehabilitation service, and the utilization of the projects are ensured by a complete support system. By this means the final goal - rehabilitation for all -could be achieved.