遠距照護與商業保險策略聯盟之研究

The study of Strategic Alliance in telehealth and Commercial Insurance

黃純文(Chun-Wen Huang)

指導教授 ： 林能白

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.10272

摘要

由於生育率逐年下降、平均壽命延長，台灣人口的結構急速變化中，六十五歲以上之老年人口，預估2025年將達19.79%。人口老化直接衝擊健保醫療費用的高漲，據衛生署2010年最新資料顯示，六十五歲以上人口佔總人口10.3%，但其所使用之醫療費用為34.4%。年齡老化會導致器官功能之退化，致使有高血壓、糖尿病及高血脂等慢性病的人數劇增。據健保局統計，高血壓門診病患每年需用掉新台幣106億元的降血壓藥，但血壓控制率仍不理想，病患若能好好控制血壓，即可降低30%至40%腦中風的發生率，也能降低50%以上心臟衰竭的發生率。
台灣以科技島聞名，若能透過科技協助，建立遠距照護來控制老年人口及慢性病患者之血壓及血糖等，除可改善國人之健康，對健保財務相信也有相當助益。經濟部及衛生署推動遠距照護服務多年，也有相當成效，惟付費機制往往是推動的癥結，幸醞釀多年的長照保險漸漸成形，2008年台灣人壽保險的投保率已達208%,，普及率也達333%，是否可以為台灣遠距照護的付費機制找到解套。
遠距照護服務的貢獻與效益，在諸多的研究及報導都已經被證實及肯定，確認這是一個值得發展的領域。然而在許多研究中，皆認為保險能為遠距照護帶來新的經營模式，但卻又認為是最困難推動及執行的，本研究即希望透過文獻探討，瞭解策略聯盟的動機、型態及選擇聯盟伙伴的評估準則，並以個案研究法，探討醫院及商業保險公司策略聯盟的試辦方式，評估其績效，找到一可行的經營模式，供未來醫療院所與保險業者合作之參考。

關鍵字

遠距照護 ； 商業保險 ； 策略聯盟

並列摘要

The average life span has been extended while the birth rate decreased every year. These two major trends have changed the structure of population rapidly in Taiwan. The population of elderly which aged over 65 years old is estimated to reach 19.79% in 2025. The direct impact of population aging will increase the cost of health insurance. According to latest information of Department of Health in 2010, the populations of 65 years or above will over 10.3% of total population. However, the medical cost of this group is about 34.4%, which is too high. Aging will lead to degradation of organ functions. Therefore, the rate of hypertension, diabetes and high cholesterol and other chronic diseases will rise dramatically. According to the statistics of National Health Insurance Bureau, the hypertension outpatient will spend about 10.6 billion NT every year on blood pressure medicine, but the control of blood pressure was still not satisfied. If the patient can control the blood pressure well, if can reduce the incident of stroke about 30 to 40 percent lower. It also can reduce the chance of heart failure more than 50 percent.
Taiwan is famous in technology around the world. Throughout the assistant of technology, we can develop a tele-medical care system to help control the high blood pressure and glucose of aging people and chronic patient. Beside it can improve the health of people; it also can reduce the cost of medical insurance. Fortunately, long term care insurance gradually forming and private commercial insurance coverage rate has reached 208%, the penetration rate has reached 333% in 2008. It maybe can be some sort of payment mechanism for Taiwan's telehealth.
The contribution and benefits of telecare services, confirmed by many studies and reports, have been affirmed that this is an area worthy of development. However, the private commercial insurance will be considered a new business model for telehealth in many studies, but still it is the more difficult part to implement In this paper, throughout the review of essay study, motive and pattern of strategy alliance, criteria assessment of selecting alliance partners, and the case study of exploring the performance of trial strategic alliance between hospital and commercial insurance companies, we hope can find a workable business collaboration model for future health institutions and private commercial insurance.

並列關鍵字

telehealth care ； commercial insurance ； strategic alliance

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