以公共衛生為基礎的政府雲端醫療照護服務分析—以臺北市政府遠距照護計畫為例

公共衛生是一直以來是人口生產力的關鍵因素。與以往針對單一病人照護的遠距醫療計畫相比，在資通訊技術的更廣泛應用下，今時今日的遠距健康計劃更廣泛的應用在人口結構的健康上。政府以建構完整的社福與醫療照護機構來實作公共衛生基礎建設。然而在服務民眾與追求社會正義的政府義務框架下，政府需要以商業計畫卻不賺取利潤的角度，思考服務的永續經營方式。透過政府的醫療照護相關法令制度，國家的醫療照護藍圖通常會由政府與非政府組織共同實現。政府的會著重在疾病預防與醫療推廣上，非政府組織則會負責公共衛生中亞健康族群的健康防護。這些醫療照護服務毫無疑慮的可以各自順利執行。但對於民眾來說，這些醫療服務的關鍵卻是在服務的整合程度上。在台灣，許多醫療照護服務是依存於健保制度，而這些既有服務間的協調與各單位間的合作卻是非常薄弱的。把範圍縮小到政府主導的公共衛生為基礎的遠距健康後，台北市遠距照護服務是唯一尚未終止的計畫。這個遠距照護計畫是由台北市政府在2008年為了整合既有的醫療照護服務所提出來的。在這個研究中，我們分析了這個計畫並試著分析出這個台北市遠距照護計畫的永續經營關鍵。分析會從幾個面向進行：服務組合、系統架構、商業模式、與效益模型。

關鍵字

遠距健康；公共衛生；雲端運算；外部性；民間興建營運後轉移模式

並列摘要

Public health is always a primary issue in population productivity. Contrasted with previous telehealth programs applied to individual patient care only, nowadays, telehealth is more broadly applied to population health due to the development and adoption of the program using a broad spectrum of information and communication technologies. Governments implement their public health program through constructing healthcare infrastructure such as social welfares and healthcare facilities. Nevertheless, beyond the obligation of serving people and achieving social justice, government thinks over the sustainability of services compulsively and dislodges any profit ideas from the business plan. The healthcare infrastructure usually constitutes with Non-government organizations (NGO) by government healthcare legislation to carry out the health map for country. Governmental healthcare focuses on the illness prevention and health promotion. NGO handle the specific protections for high-risk group in public health. These healthcare services are implemented well separately and undoubtedly, but the key factor for people is the level of healthcare services integration. Many healthcare services are operating well along with the national health insurance system in Taiwan. However, the collaboration within existing services and cooperation between departments are still fragile. After narrow the scope to the government lead telehealth program based on public health in Taiwan, Taipei telecare program is the only survived program. Taipei city government proposed the telecare program in 2008 to integrate existing healthcare services. In this study, we analyze the program and try to figure out the key factors in sustentation of governmental telehealth program. The analyses are from four different aspects: service combinations, system infrastructure, business model, and utility model.

並列關鍵字

telehealth ； public health ； cloud computing ； externalities ； build-operate-transfer

參考文獻

Breau-of-NHI. (2011). National Health Insurance in Taiwan, 2010. Bureau of National Health Insurance, Department of Health, Executive Yuan, 2011.

Alverson, D. C., Edison, K., Flournoy, L., Korte, B., Magruder, C., & Miller, C. (2010). Telehealth tools for public health, emergency, or disaster preparedness and response: a summary report. Telemedicine and e-Health, 16(1), 112-114.

Bower, P., Cartwright, M., Hirani, S. P., Barlow, J., Hendy, J., Knapp, M., . . . Bardsley, M. (2011). A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial. BMC health services research, 11(1), 184.

Buchanan, J. M., & Stubblebine, W. C. (1962). Externality. Economica, 29(116), 371-384.

Cohen, J. T., Neumann, P. J., & Weinstein, M. C. (2008). Does preventive care save money? health economics and the presidential candidates. New England Journal of Medicine, 358(7), 661-663.

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以公共衛生為基礎的政府雲端醫療照護服務分析—以臺北市政府遠距照護計畫為例

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