面對國人的人口老化及老年人慢性疾病逐年升高趨勢，隨著國人生活水準改善，醫療技術提升，平均餘命亦逐年提高；尤其，近年來國人平均餘命上升幅度較往年更為快速，加上少子化現象，對於衍生之老人照護問題，值得政府及民間各界重視。政府近年來大力推動長期照護政策，2007年推動「我國長期照顧十年計畫」，2009年底將「長期照護保險法」草案送立法院審議，預定2011年後實施長期照護保險制度。給付型態以實物給付（服務提供）為主，現金給付為輔，給付水準區分四級，且有補助時數限制。草案中引進「部分負擔」作法，超過政府補助時數，將由民眾全部自行負擔照護費用，可見被照護者或家屬所須負擔之照護費用及精神壓力，仍是一項沈重的負擔。 依據經建會委託長期照護服務需求評估報告及我國長期照護資源供給調查報告，顯示未來長期照護服務需求與照護資源供給相差甚遠。綜觀各國政府所提供之長期照護保障，以基本保障及服務為原則，若要達到讓身心功能障礙者，能夠增進獨立生活能力，提升生活品質，以維持尊嚴與自主之目的，當然，須要靠商業長期看護保險的補充，才能架構完整的長期照護保障網絡。 觀察國內在1995年全民健保制度實施後，明顯激發了民眾對於商業保險之健康醫療保險商品需求的重視與認同。以全民健保制度開辦當年(即1995年)至2004年，此十年間的商業健康保險保費收入來看，十年之間健康險保費收入成長超過七倍。顯示政府推動全民健保制度後，不但激發民眾潛在需求意識，而且促進商業保險商品多元化快速發展。依照先進國家在長期看護保險商品市場的發展經驗，保險公司除重視其商品架構之開發，針對消費者對於長期看護保險的各種認知問題，也應要求業務人員在銷售過程說明清楚，以擴大潛在商機，及避免日後產生非必要之爭議。 有鑑於此，本研究除了詳細彙整介紹德國、日本及台灣政府長期照護制度現況，並對於美國、日本及台灣長期看護保險商品市場進行深入介紹與探討，且對於美國、英國長期看護保險消費者購買須知進行深入介紹與探討。目的在藉由本研究之介紹與探討之結果，提供台灣保險產業長期看護保險之商品開發、業務推動及編製長期看護保險消費者購買須知等實務運作之重要參考。拋磚引玉，期待保險產業有志之士一起掌握藍海商機，協助消費者購買到適合自己的長期看護保險保單。 / Aging population is a topical issue to today’s society, with improved living standard, advanced medical technology, and rising trend of chronic diseases; causing life expectancy to increase year by year. As a result of faster increase in life expectancy in recent years, together with the phenomenon of low birth rates, long-term care is an issue that should be taken seriously to both the public and the government. Recently, the government has been promoting long-term care policy vigorously, where it published “Taiwan’s 10 Years Long-term Care Program” in 2007, submitted “Long-term Care Insurance Law ” draft to the Legislative Yuan of Republic of China by end of 2009, and is scheduled to implement “Long Term Care Insurance” by 2011. Long-term care benefits provided by the government can be classified into four levels, and the benefits will mainly be service based, with hours limit, supported by cash payments. This means that, any long-term care exceeding government’s limit will have to be paid by the user, which may be a stress and burden, financially and mentally, to the family of those needing long-term care. According to “Long-term Care Service Needs Assessment Report” and “Supply of Long-term Care Resources Survey Report” consigned by the Council for Economic Planning and Development, it can be seen that the supply of long-term care resources can never quite meet the demand of long-term care services. After studying long-term care benefits provided by other governments, it is clear that commercial insurance is essential to allow people requiring long-term care to maintain a full standard of living. This may includes being able to live independently, to improve the quality of life, and to maintain one’s dignity. By observing the National Health Insurance （NHI） in Taiwan, implemented in 1995, it has stimulate people to be aware of their personal needs towards private health insurance products. The premium of private health insurance products had been increased by seven times from 1995 to 2004. It has been proven that government’s strong support on the NHI has help people to better understand the demands on their health protection, and at the same time, diversify private health insurance products. An overview on the experience of developing private long-term care insurance products in developed countries, insurance companies not only focus their core competence on developing insurance products but also pay attention on maintaining customers’ satisfaction, customer loyalty and customer retention. It is essential that insurance sales agents should help clients choose insurance policies that suit their needs by explaining policies in detail, in order to create new business opportunities and prevent from any future claim conflict or argument. In view of this, the purpose of this research is to firstly introduce the long-term care system in countries such as German, Japan and Taiwan, study on the experience of developing private long-term care insurance products in developed countries, and follow by an in-depth study and discussion about U.S. and U.K. shopper’s guide to long-term care insurances. Moreover, the findings of this dissertation can hopefully provide suggestions to insurance companies on development of long-term care insurance products and help building consumers satisfaction and consumer retention. To conclude, it is important to create a win-win solution to both customers and insurance companies, where insurers shall develop long-term care products that satisfy customers’ need and in return profit from the market opportunities.

全球遠端醫療產業蓬勃發展，各國家的法規也越來越明朗化，未來醫療需求將隨人口老化而大幅上升，如何利用新型態的醫療方式來解決醫療問題，便成為國際上討論的趨勢。本文以遠端藥事做為研究目標，透過「iHealth政昇處方宅配藥局」服務全台的經營模式，以及「春森藥局」服務社區式的經營模式，比較兩家藥局的施行歷程，如何以不同的形態達成遠端藥事。 本研究以Osterwalder提出之經營模式圖(Business Model Canvas)做為基礎，論文以商業畫布、市場機會的發掘與辨識、興業的商業概念、興業的執行、興業的成果呈現，探討機構的獲利方式、民眾的營收方式、藥事服務的形式、慢性病照護，以及政策性的醫療網絡建構等…議題，皆可做為政府規劃醫療政策之參考，本研究有別於其他遠端醫療研究多半選擇科技之論述，以藥局經營做為研究對象，探討產業商機所在。 研究結果顯示，台灣遠端藥事可以符合在現有的法規之上，藥局經由的通訊科技聯繫到病患，提供連續處方箋獲利，不需要依靠業外收入，達成藥事服務營利。比較特別的事，不同藥局要施行遠端藥事的動機不同，分別有企業藥局的經營導向，協助機構評鑑、提供民眾的宅配，此模式下的遠端藥事僅為企業願景的一部分，最終以平台建製作為目標；另一種模式為個人藥局的經營導向，藥師透過政策接觸到社區病患，提供居家服務、甚至安寧服務，實現全人照護之目標。 本研究認為，台灣的遠端藥事尚有發展之潛能。企業經營的方向，需要以機構做為穩定現金流的基礎；個人經營的方向，依然以自身的使命感為主，然而配合「遠端醫療法案」鬆綁、「居家照護政策」的補助，建製完善的社區醫療網絡，將有助於提升社區藥局參與遠端藥事服務之意願，形成新型的產業模式。 / As the telemedicine industry flourishing, the regulations became clear among the countries, the medical needs will also increase in the future. As the goal of the research, this dissertation focused on telepharmacy, the research compared two pharmacies with two different models: serves-the-entire-Taiwan bussiness model from 「iHealth政昇處方宅配藥局」, and serves-the-community bussiness model from 「春森藥局」, hoping to be able to present the telepharmacy with different forms and conditions. This research used the Business Model Canvas which was presented by Osterwalder as the foundation, Unlike other telemedicine researches, this research explored the industry opportunities, and focused on the pharmacy management perspective, instead of the science perspective. The result shows that the telepharmacy in Taiwan can be consistent with the existing regulations. What is more special is that, different pharmacies have different motivations for telepharmacy, and the telepharmacy under this model is only part of the enterprise vision, and creates Platform as the final goal; another model is the business directoin of personal pharmacy, pharmacist contacts patients in the communities through policies, provide home services, and hospice home care to achieve the goal of holistic care. This study considers that telepharmacy still has the potential for development. The direction of enterprise management needs to be based on institutions as the basis of stable cash flow; the direction of personal management sill based on their sense of mission. However, with the help of telepharmacy laws and home care policies, through building the well rounded community medical network, can help increasing the wills of the community pharmacies to participate in telepharmacy.

本研究以民國97年5月23日總統公布民法總則編修正條文第14條、15條，增訂第15條之1及第15條之2，民法親屬編第4章監護與輔助制度之新規定，以及法院實務運作為探討重心，輔以分析比較大陸法系國家--德國成年照護制度與日本成年後見制度，以及英美法系國家--英國2005年意思能力法案與美國2006年統一代理權授與授權法之制度，以針對我國學者對於新成年監護制度之見解與目前實務運作所產生之問題為之探討，以提出以下結論與建議：一、基於尊重本人自主權之理念，未來應制定意定監護制度。二、法定監護制度之修正：(1)意思能力之判斷原則應有明確規範，並以英國2005年意思能力法五項指導原則為判斷守則。(2)不應一律剝奪受監護宣告人之行為能力。(3)監護聲請權人應增列未成年監護人、同居人與同性生活伴侶。(4)受破產宣告之人雖不可為財產管理之監護人，但可為身上照護之監護人。(5)監護事務方面，關於重大醫療照護等身上監護事項應明文規定交由法院審查。(6)受監護人之自主權與保護受監護人之利益應有所平衡。(7)建議增列繼任監護人，以及解決監護關係相對終了，因監護人無繼承人時，無人管理受監護人財產移交與結算事項等問題。(8)輔助宣告方面：因輔助人只有同意權無代理權可代受輔助人行使所物返還請求權，為保護受輔助人，可由法院賦予輔助人行使特定財產行為之代理權。(9)最佳利益原則：法院應鼓勵受監護人參與監護事務之決定，並考量受監護宣告之人過去、現在願望與感受，以及受監護宣告之人之價值觀和信仰如何影響其決定，亦即受監護人即便現在欠缺意思能力，其意見仍應予以尊重。三、監護監督制度是監護制度成功與否之重要機制，鑒於國外成年監護制度均設有監護監督機構，以支援法院為監護監督工作，又考量監護品質之維護，我國未來應設立協助法院監督之機關。 / This research is intended to study the amendments of Civil Code, Article 14, Article 15, Article 15-1, Article 15-2, and Section 2 Guardianship and Assistantship over Adults of Chapter IV announced by the President on May 23, 2008, and to investigate the adult guardianship cases. Furthermore, this research chooses four advanced countries--Germany, Japan, the United Kingdom and the United States to compare and analyze their legal systems of adult guardianship. Those countries’ adult guardianship legal systems and the scholars’ viewpoint provide the following conclusions and suggestions: First, according to the underlying philosophy of respecting decision-making power of the ward, we should establish the voluntarily nominated guardian model. Secondly, the Adult Guardianship Act should be amended：(1) A definite standard for a person’s capacity of evaluation should be clarified. We can adopt the UK Mental Capacity Act 2005, the five statutory principles to help evaluate if a person lacks capacity. (2) The Act should not deprive a person of all his legal capacity, when once a person is declared incapacity by the family court. (3) The Act’s applicants should include minor guardian and civil partnership. (4) Guardians who are bankrupt will no longer be allowed to act as guardians for property and affairs but can still act as guardians for personal welfare. (5) The ward’s personal welfare decisions on serious healthcare and treatment should be put before the family court for approval. (6) The act should aim to balance an individual’s right to make decisions for themselves with their right to be protected from harm if they lack capacity to make decisions to protect themselves. (7) The guardian’s authority terminates when the guardian dies. However, a problem will arise from it. The problem is that if the guardian does not have a successor, the guardian cannot transfer the ward’s property to a new guardian. To solve the problem, adopting a successor guardian may be a good method. (8)The assistance (advisory) system：Because assistants do not have authority to take actions to ask the third person to give back the person’s property, the authority should be granted to assistants by the family court in order to protect their interests. (9) Best interests: The family court must consider the ward’s past and present wishes, feelings, beliefs and values that would be likely to influence his/her decision if he or she had capacity. Thirdly, monitoring guardian system can help adult guardianship system to operate successfully, and protect those wards. Many countries such as Germany, Japan, the United Kingdom and the United States are all devoted to developing their monitoring guardian system. In taking the quality of the adult guardianship into consideration, our country should establish monitoring guardian system in the future.