日本保險制度給付藥事照護之沿革

Evolution of Reimbursement for Pharmaceutical Care in Japan

日本的厚生勞動省平均每二年修正一次醫療保險的給付，藉由給付的調整，逐步推動政府的各項政策，如醫藥分業、家庭藥師制度及減少門前藥局等。此外，在日本，由藥師所提供的知識性藥事服務 自1988年起可申請保險給付，且在各藥學會、公會及政府的共同努力下，給付逐年提高，藉此鼓勵藥師 參與醫療團隊，主動提供專業藥事服務，全面提升醫療服務的品質。本文就日本保險制度中的藥事服務給付對醫藥分業、醫院藥師業務演進及專科藥師制度等面向的影響，進行簡單的說明及討論，期能做為未來我國健保給付制度調整的參考，藉此提供給國人更安全有效且高品質的醫療照護。

In the past, the Ministry of Health, Labor and Welfare (MHLW) of Japan revised the reimbursement standard of national health insurance system every 2 years. Through the adjustments, the government had promoted some important policies, such as the separation of pharmacy from medicine, family pharmacists, and reducing clinics affiliated pharmacies. Moreover, cognitive pharmaceutical services provided by pharmacists could be reimbursed in Japan since 1988. Because of the efforts of the pharmaceutical associations, societies, and government, the cognitive pharmaceutical service fees were increased gradually. Therefore, pharmacists were encouraged to participate in the medical teams, and provide professional services to improve the quality of medical care. In this article, we present and discuss the influence of the pharmaceutical reimbursements in the separation of pharmacy from medicine, the evolution of pharmaceutical practice in hospital, and the specialist pharmacists system in Japan. The experience of Japan may be a good reference for national health insurance revision in Taiwan to provide a model with safer and more effective medical care for patients.