臺灣、日本與新加坡居家醫療現況之比較

Home Medical Care in Japan, Singapore and Taiwan: A Comparative Study

亞洲因應高齡化社會的到來，被迫進行醫療體制的改革，故近年來居家醫療逐漸受到重視，許多政策推動及相關機構的設立都逐漸成熟。臺灣自2016年開始試辦居家醫療照護整合計畫，結合新長照政策的推動，努力朝著「在地老化」的宗旨前進。日本因老年人口組成在2006年就已經達全國人口的20%，所以針對醫療制度的改革較其他亞洲國家來的早，也成為全世界長期照護領域的典範。新加坡因其特殊的醫療制度，大幅降低醫療資源浪費，但也因為人口老化快速的關係迫使衛生部對醫療及長照保險做變更，希望能對無力付擔居家照護費用的失能長者提供更多的補助。臺灣居家醫療整合計劃從2015年開始實施，欲整合現行不同類型片段式的居家醫療服務模式。臺北市立聯合醫院以醫護人員為居家醫療團隊基礎，跨領域提供其他專業人員如藥師、營養師…等訪視服務，至今已訪視超過兩萬人次，已逐步建構起其運作模式，並於日本參訪經驗中看到許多制度的差異。本篇文章就新加坡的居家照護現況與實地訪查日本基層診所實行在宅醫療的經驗，比較分析臺灣居家醫療的執行，那些政策可繼續保留進而發揚光大？而那些地方可改善並提升照護品質。 As the accelerating pace of population aging has triggered reformations of medical systems and policies in Asia, home medical/nursing care has begun to flourish in recent years with more and more policies implemented and institutions established to support the trend. Taiwan's National Health Insurance Administration has launched the pilot project of “Integrated Home Care” and new policy for long-term care to promote the concept of “aging in place.” With the percentage of its elderly population reaching 20% as early as in 2006, Japan has initiated several measures to reform its medical care systems, and the result is a long-term care system generally considered a paradigm for emulation. In Singapore, a health care financing system based on individual responsibility for health care costs has helped reduce avoidable healthcare expenses. However, in the face of rapid population aging, the Singapore Ministry of Health has been forced to reform its healthcare and long-term care insurance systems with the aim of helping elderly citizens with severe disabilities cope with the financial burden of their daily care. In Taiwan, the Ministry of Health and Welfare has offered since 2015 integrated home-based care services to people meeting specified criteria. Working on home-based medical care for nearly two years, Taipei City Hospital (TCH) has provided residents home-based medical/nursing services for more than 20,000 times. TCH organizes multidisciplinary teams visiting patients at home and attempts to establish an integrated home-based care model. By comparing the home care systems in Japan, Singapore, and Taiwan, the article aims to identify the areas for promotion, development, and improvement in enhancing the efficiency and effectiveness of the home care system in Taiwan.