以遠距醫療優化高齡長者醫療照護之商業模式個案研究

過去一百年來，已開發國家的人均預期壽命增加了一倍，若人類壽命的延長沒有伴隨健康歲月的延伸，高齡長者將為慢性病的長期負擔所困擾；全球老年人口最多且老化速度最快的是在亞洲，台灣則是全球老化速度數一數二的國家，未來高齡長者的醫療照顧將是沉重的負擔。國人雖有世人稱羨的全民健保醫療制度，高齡病患仍有許多未被滿足的醫療需求，遠距醫療將會是重要的解決辦法之一。遠距醫療係將醫療資源擴展到需要醫療照護的人，而不受到距離與時間障礙的影響，在新冠肺炎大流行期間，遠距醫療在全球被廣泛地使用而已驗證其臨床價值。因此，本研究旨在回顧國內外有關遠距醫療的文獻及其臨床使用經驗，進而討論如何配合國情建構以「遠距醫療」優化高齡長者醫療照護的商業模式。爰此，本研究個案選擇區域級L醫院，建構遠距醫療用於高齡照護的可行商業服務。L醫院於1995年創立，是台灣唯一由醫療專業人員組成的經營團隊，25年來的努力下，首創全國第一個社區醫療群及公衛群，成為南桃園地區首屈一指的區域級教學醫院。本研究以L醫院為基礎，在預期未來可見的六種醫療情境下，提出遠距醫療優化高齡長者醫療照護的方案，其長遠目標是以「病人需求為核心」的全方位照護，建構涵蓋食衣住行育樂並結合保險業的「跨產業健康管理服務生態圈」商業模式，以維護長者的健康、提升生活品質。當新冠肺炎疫情降級後，遠距醫療是否應恢復疫情前之限制或順勢開放，仁智之見各有其理。然而，遠距醫療已是國際的醫療發展必然趨勢，與其消極地擔心遠距醫療遭濫用，不如全盤檢討建立遠距醫療的護欄，界定最適合與最不適合遠距醫療的適應症、建立醫療人員應遵守的臨床規範以確保醫療品質的維持、及排除不必要的監管行政措施以優化視訊流程的順暢。如此，高齡長者的醫療照護將因遠距醫療而優化。

關鍵字

遠距醫療；老年醫學；老年人；醫療品質；商業模式

並列摘要

During the past 100 years, the average human life expectancy has doubled in most developed countries. If longer human life span is not accompanied by the extension of health span, the elderly will be suffered from long-term burden of chronic diseases. The world’s largest elderly population and the fastest rate of aging is in Asia and Taiwan is the country with the highest rate of aging in the world. Thus, the medical care of the elderly will be our heavy burden in the future. Although we have a universal health care system that is admired by the world, elderly patients still have many unmet medical needs. Telemedicine will be one of the important solutions. During the COVID-19 pandemic, telemedicine has been widely used around the world proving its merits and clinical value for extending the reach of medical resources to those in need of care regardless of distance and time barrier. Therefore, this study aims to review the literature on telemedicine and its clinical applications in Taiwan and abroad. We then discuss how to construct a business model that optimizes the medical care of the elderly with “telemedicine” in line with national conditions. In view of this, this study undertook a case research based on a regional hospital (L-Hospital) to apply telemedicine in caring geriatric patients with a feasible business services. Founded in 1995, L Hospital is the only operating team composed of medical professionals in Taiwan. After 25 years’ effort it has created the country’s first community medical group and public health group, and has become the leading Regional Teaching Hospital in South Taoyuan. Based on L Hospital, this study proposes a plan for telemedicine to optimize medical care of the elderly under six scenarios that are expected to be visible in the future. The long-term goal is to establish a “Cross-industry Health Management Service Ecosystem” business model to maintain the health of the elderly and improve their quality of life with participation of insurance industry. It covers the needs of the elderly in food, clothing, housing, transportation, education, and entertainment. Telemedicine is an inevitable trend in medical care globally. When COVID-19 pandemic is downgraded, whether telemedicine should resume the restrictions before the pandemic or open up with the trend is controversial. Instead of passively worrying about the abuse of telemedicine, it is better to comprehensively review and build the guardrail of telemedicine, such as to define the most suitable and least suitable indications for telemedicine, establish the clinical norms that medical personnel should follow to ensure the maintenance of medical quality, and to eliminate unnecessary regulatory procedures to optimize the practice of telemecine. In this way, the medical care of the elderly will be optimized due to telemedicine.