臺灣居家醫療照護整合發展及困境：日本在宅醫療的啟示

The Development of Home Medical Care and Its Hindrance in Taiwan: Lessons from Japan's Home Medical Care

劉家勇(Hubert Chia-Yung Liu)

《台灣老年醫學暨老年學會雜誌》 15卷3期 (2020/08) Pp. 182-198

https://doi.org/10.29461/TGGa.202008_15(3).0003

摘要

目的：探討我國居家醫療整合服務模式與日本在宅醫療在照護提供、發展模式與營運型態上的差異，作為未來我國推展居家醫療照護整合服務模式之參考。方法：採質性研究途徑（qualitative research approach），以半結構式深度訪談，將逐字稿謄錄後以試算表軟體，進行概念化分析。抽樣方法為滾雪球式抽樣（snow ball sampling）。結果：本研究共收案6名專家、學者及第一線參與居家醫療照護整合工作者。結果分析依照護提供、發展模式與營運型態三面向加以分析。發現居家醫療照護整合是照護服務典範的轉移，但臺灣對其定位與功能仍待釐清與一致化，缺少配套及整合；發展模式上，臺灣依靠政策計劃推動，而日本則依靠多元專業團隊深耕社區，且財務方面日本較臺灣更為彈性多元；營運型態則受到文化與醫病關係差異的影響，且整體醫療制度面的規劃與運作效益有關。討論：目前臺灣的居家醫療照護整合尚在推廣中，未來在長照政策的推動下，應需要更進一步的研究，獲得更多本土經驗，以改善現有制度的不足，使之成為有別於門診、住院診療外的「第三種醫療」。

關鍵字

居家醫療 ； 在宅醫療 ； 臺灣 ； 日本

並列摘要

Objectives: The study aims to examine the home medical care (HMC) systems in both Taiwan and Japan. Their features and differences were analyzed to obtain results for the future improvement of home medical care in Taiwan. Method: The study conducted in-depth, face-to-face qualitative interviews to collect empirical data regarding the practice and development of HMC in Taiwan. Selected based on snowball sampling, interviewees included 6 experts in related fields and frontline HMC doctors and workers. Results: The study focused on the following three major aspects of HMC: care provision, development model, and management style. Regarding care provision, HMC marked a significant shift in the paradigm of elderly care in Taiwan; both of its goals and functions needed to be better clarified to help facilitate future development. In terms of development model, Taiwan relied on a policy-driven model supported mainly by government projects, whereas Japan had its HMC developed by the collective and orchestrated efforts of community-based professional groups with more diversified and flexible sources of funding. Finally, the management styles of the HMC systems in the two countries were under the influence of differences in culture and doctor-patient relationship, as well as in the overall operational planning and effectiveness of their health care systems. Conclusion: Though still in its nascence, the development of HMC can be expected to play an increasingly crucial role in Taiwan in response to the needs of its rapidly aging society. More studies are needed to accumulate richer local data and experiences to expedite ongoing improvement of the existing system. The research as a preliminary study offers the lessons of the HMC system in Japan that should be taken into consideration for future development of HMC in Taiwan.

並列關鍵字

home medical care (HMC) ； home health care (HHC) ； Taiwan ； Japan