英國遠距健康照護的演進–他山之石可以攻錯

The Evolution of Remote Healthcare in the UK: lessons transferrable to Taiwan

顏弘毅(Hung-Yi Yen)

指導教授 ： 林欣美

國立暨南國際大學/管理學院/經營管理碩士學位學程在職專班/碩士(2015年)

摘要

21世紀科技進步的與醫療，藥物的不斷研發和創新，醫療人權的提升及自我保健觀念高漲，加上網路資訊飛速翻傳。各種因素延長了人類的壽命及生活品質。導致傳統的急症醫療照護面臨改變與挑戰。高齡化合併慢性病的增加導致長期照護和預防保健照護的需求與日俱增。健康福利照顧制度是各國政府的重大施政任務與預算支出的重點。如何在預算有限，醫護照護人力缺乏，的困境之中發展全人整合照顧的福政是醫療政策的重大課題。

英國政府於1940年已開始發展居家照護(Telecare),在2002年擴大居家照護的應用層面，更在2007年開始推行遠距健康照護(Telehealth) 期待經由實際的慢性病(主要為充血性心臟病,慢性阻塞性肺病以及糖尿病)的照護結果在心理生理層面，以及醫療有關的急診率，就醫率 ，住院曰數，死亡率方面比較介入前與介入後的實際成果並經由量化(RCT)學術研究以及質性的研究與發展來探討研究全面實行整合照護的可行性。英國早在1948年已實施公醫制度而台灣的全民健保康保險也在1995年實施至今。臺灣曾在2003經由衛生部門派代表到英國考察NHS制度的再造。以及2008考察英國遠距健康照護實際的實施狀況，希望習取英國在的遠距照護経驗與精神來做為推動臺灣遠距健康照護服務的參考。

本研究運用PEST分析及關鍵成功因素的探討並透過對國內外遠距醫療及健康照護產業相關文獻之回顧與分析，實際瞭解英國醫療現況與推動遠距健康照護計畫之實際狀況，希望對於英國於政府端政策的演變，地方端及機構端的組織再造，照護提供端的利弊得失，産業端的標準化以及規模化，使用端及一般照護者端的身心層面的影響做詳細的研究 並探討在各階段面臨的問題與解決方法。找出願景與遠景期望有助於遠距健康照護服務之實際應用推展。

關鍵字

遠距居家照護 ； 遠距健康照護 ； 隨機控制實驗 ； PEST分析 ； 關鍵成功因素

並列摘要

The 21st century has encouraged the progression of science and technology in the medical and pharmaceutical industries through continuous research, development and innovation. Increased awareness of human rights and self-care concepts have been promoted as information is rapidly accessible across expanded networks resulting in the rise of quality human life particularly in the remote health industry.

As traditional medical care faces changes and challenges, an increase in ageing has also led to higher demand of long-term, chronic and preventive health care. Due to the importance of health and welfare systems, policy and budget expenditures will be analysed to improve the development of holistic integration preparing for future implementation. Currently, major dilemmas include limited budgets, medical care supplies, manpower and government support.

Though remote health care has been trialed in the past, in 1940, the British government began the development of home care (Telecare) with an expansion to home application in 2002 via the remote health program in 2007 (Telehealth). Main diseases targeted by initial Telehealth trials were chronic conditions such as heart failure, obstructive pulmonary disease and diabetes. As a result, reports of psychological and physiological care satisfaction increased while emergency medical treatment and general hospitalization rates decreased. The actual results of interventional and quantifiable (RCT) academic research are still being explored for feasibility with hopes leading to a fully integrated remote health care program in the near future.

The British public health system began remote health care trials as early as 1948 compared to the National Health Insurance (NHI) in Taiwan in 1995 meaning more experience and available information relates to the UK program.

The healthcare relationship between Taiwan and the UK is strong due to a formal invitation back in 2003 on behalf of the United Kingdom to examine the Ministry of Health through the NHS system perspective. Since then, remote health offering has been growing in Taiwan with backing by the NHS as more studies supporting the benefits of remote health are being published. Therefore this thesis will explore and analyse previous remote care in the UK to bring best practice to future programs in Taiwan.
A PEST and Critical Success Factors analysis for both domestic and international remote health care will be provided to further understand the medical situation in the UK and to promote long-distance health care plans. Pros and cons of policy and impact to institutions, care providers, user physical and mental aspects will be detailed and explored. Finally, the vision of remote health in Taiwan and suggestions for future policy and programs will be provided to fuel the practical application of remote health care.

並列關鍵字

telecare ； elehealth ； RCT ； PEST Analysis ； CSF

參考文獻

1. Appleby, J. 2012, Future funding scenarios, The King’s Fund: Time to Think Differently. Retrieved 5th March 2014, fromhttp://www.kingsfund.org.uk/time-to-think-differently/trends/economic-pressures/historic-trends-health-care-spending.

2. Appleby, J. 2012, Rises in healthcare spending: where will it end? British Medical Journal, 2012; 345.

3. Appleton, N. 2003, A brief introduction to UK Sheltered Housing and Very Sheltered Housing. SJR Committee: Policy Review - Housing needs of older people 2003. Retrieved 2nd Jan, from http://www.assembly.wales/Committee%20Documents/.

4. Appleton, N. 2004, A brief introduction to UK Sheltered Housing and Very Sheltered Housing. 2004; SJR Committee-03.

5. American Telemedicine Association (ATA). 2007, Telemedicine/Telehealth Terminology. Washington, DC 2007: ATA.