遠距醫療法制之研究

Institute of Technology Law National Yang Ming Chiao Tung University Master Thesis

系所名稱：科技法律研究所
學位別：碩士
畢業學年：111
指導教授：陳鋕雄
遠距醫療作為數位科技與醫療照護之結合，克服了因距離產生之就醫障礙，有效解決醫療資源不足及分布不均等問題，並因可提供資訊傳輸、遠端監測、互動交流，能夠降低醫療照護人員與病人之間接觸感染的風險，而在新型冠狀病毒肺炎疫情全球大流行期間獲得國際重視與廣泛應用。惟前述遠距醫療之施行，於我國受有現行《醫師法》第11條及《通訊診察治療辦法》規定之限制，原則上醫師須親自診察，僅於山地、離島、偏僻地區或有特殊、急迫情形下，例外允許醫師以通訊方式進行診療，加上針對特殊情形病人之其他規範，如排除初診病人和禁止開立處方，導致國內遠距醫療產業發展速度較他國緩慢。此外，由於目前我國尚未開放實施遠距醫療之醫療院所以郵寄或快遞方式寄送藥品到病人家中，因此病人接受線上看診後仍需至醫療院所、藥局，或由藥師送藥到府，方能領取處方箋及藥品，無法充分發揮遠距醫療之效益。
本文將以我國消除阻礙和加速推動遠距醫療的法制為研究目的，比較美國、日本、新加坡此三推動遠距醫療有成國家之法制與政策為研究方法，佐以新加坡推動遠距藥事照護服務之經驗，再回到我國面臨的各項議題進行反思，從各國法制規範及相關配套措施中尋找可供借鏡之處，最終建議我國立法者和主管機關，不能僅從彌補偏鄉醫療資源缺乏之角度出發，尚須考量到都市地區之醫療服務與長期照護需求，除了擴大遠距醫療之適用場域、減少限制條件外，更應適度鬆綁有關藥品交付及用藥指導之相關規定，以提供病人連貫且完善的醫療服務，裨益將來修法、立法上之參考基礎。讓遠距醫療相關法律規範之制定更符合我國的需求，亦順應國際發展與產業趨勢。

Telemedicine, the application of technology to healthcare, has the potential to revolutionize healthcare delivery by overcoming geographical barriers. It effectively addresses the issues of inadequacy and unequal distribution of healthcare resources. During the COVID-19 pandemic, there has been a significant rise in the use of telemedicine worldwide attributed to the surge in patients seeking health care services through information transmission, remote monitoring, and interactive communication. However, Taiwan continues to lag behind other nations in the implementation of telemedicine due to constraints imposed by Article 11 of the Physicians Act and the Rules of Medical Diagnosis and Treatment by Telecommunications. Generally, physicians are required to conduct inperson diagnostic examinations before initiating treatment, with exceptions allowed only in mountainous areas, outlying islands, remote regions, or special urgent circumstances, where telecommunication-based consultations are permitted. Moreover, the government has not yet to authorize the delivery of medication to patients’ homes through postal or courier services. As a result, patients are still required to visit medical institutions or pharmacies or rely on pharmacists to deliver medications to their homes to collect their prescriptions.
The core idea of this study is to thoroughly examine the legal framework in Taiwan to eliminate barriers that hinder the progress of telemedicine. The study compares the legal systems and policies of successful telemedicine-promoting countries, namely the United States, Japan, and Singapore, along with learning from Singapore’s experiences in promoting telepharmacy services. Drawing on the legal framework of telemedicine in these countries, the study reflects on issues in Taiwan and seeks for guidance. In line with the research objectives, this study proposes recommendations for legislators and regulatory authorities, including expanding the scope of telemedicine, reducing restrictions, and appropriately relaxing regulations related to pharmacist dispensing and medication delivery. It is anticipated that the insights gained from this study will serve as a reference foundation for future law amendments and legislation, making the formulation of telemedicine-related legal norms more in line with our country’s needs and in accordance with global developments and industry trends.