Publications-Theses
Article View/Open
Publication Export
-
Google ScholarTM
NCCU Library
Citation Infomation
Related Publications in TAIR
題名 後疫情時代遠距醫療使用率下降之比較分析--台灣與日本之政策、實施與使用者因素
Post-COVID Telemedicine Usage Decline: A Comparative Analysis of Policy, Implementation, and User Factors in Taiwan and Japan作者 潘立珊
Pan, Li-Shan貢獻者 連賢明
Lien, Hsien-Ming
潘立珊
Pan, Li-Shan關鍵詞 遠距醫療
遠距健康
COVID-19
後疫情
視訊門診
遠距照護
telemedicine
telehealth
COVID-19
post-pandemic
healthcare policy
digital health日期 2025 上傳時間 1-Jul-2025 15:10:53 (UTC+8) 摘要 COVID-19疫情在全球催化了前所未有的遠距醫療採用，然而到2023-2024年，日本和台灣的使用率均已回落接近至疫情前水平。本研究透過分析政策演變、系統設備和使用者因素，探討兩個技術先進醫療體系中後疫情時代遠距醫療使用率下降的因素。本研究採用2018-2024年醫療政策和全國使用率數據的文件分析，並輔以台灣醫療專業人員的訪談，調查遠距醫療成長為何無法持續。研究結論指出，不同的政策轉型策略導致了相似的結果，顯示遠距醫療採用面臨超越監管方法的結構性挑戰。未來的整合可能需要混合模式，在承認醫療互動的具身性本質的同時，善用科技的可及性優勢。
The COVID-19 pandemic catalyzed unprecedented telemedicine adoption across East Asia, yet by 2023-2024, usage rates in both Japan and Taiwan had declined to pre- pandemic levels. This comparative study examines factors contributing to this post- pandemic decline through analysis of policy evolution, system implementation, and user adoption patterns in two technologically advanced healthcare systems. Using document analysis of healthcare policies and national utilization data from 2018-2024, national utilization data supplemented by interviews with Taiwanese healthcare professionals, this research investigates why telemedicine gains proved unsustainable. Key findings reveal Japan's graduated policy approach maintained telemedicine reimbursement at 87% of in-person rates, creating financial disincentives. Taiwan's "reset-and-rebuild" strategy restricted coverage to specialized populations. Both countries faced technical challenges, including low digital identity adoption and legacy system integration difficulties. Interview findings demonstrate that Taiwanese healthcare professionals maintain low preference for telemedicine due to concerns about clinical assessment limitations and disrupted trust-building mechanisms in virtual environments. The research concludes that different policy transition strategies led to similar outcomes, suggesting telemedicine adoption in East Asian contexts faces structural challenges transcending regulatory approaches. Future integration requires hybrid models that acknowledge the embodied nature of medical interactions while leveraging technology's accessibility benefits of technology.參考文獻 Akiyama, M., & Yoo, B. K. (2016). A Systematic Review of the Economic Evaluation of Telemedicine in Japan. J Prev Med Public Health, 49(4), 183-196. https://doi.org/10.3961/jpmph.16.043 Aung, M. N., Koyanagi, Y., Nagamine, Y., Nam, E. W., Mulati, N., Kyaw, M. Y., Moolphate, S., Shirayama, Y., Nonaka, K., Field, M., Cheung, P., & Yuasa, M. (2022). Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand. Int J Environ Res Public Health, 19(12). https://doi.org/10.3390/ijerph19126976 Cabinet Office, G. o. J. (2021). 規制改革実施計画 [Regulatory Reform Implementation Plan]. Retrieved from https://www8.cao.go.jp/kisei-kaikaku/kisei/publication/keikaku/210618/keikaku.pdf CECC. (2020). 肺中指字第1093800108號. Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081049700-1120323-1000-003.pdf Chiu, K. H., & Yang, Y. Y. (2010). Remote monitoring of health status of the elderly at home in Taiwan. Telemed J E Health, 16(6), 717-726. https://doi.org/10.1089/tmj.2010.0006 Ezeamii, V. C., Okobi, O. E., Wambai-Sani, H., Perera, G. S., Zaynieva, S., Okonkwo, C. C., Ohaiba, M. M., William-Enemali, P. C., Obodo, O. R., & Obiefuna, N. G. (2024). Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus, 16(7), e63881. https://doi.org/10.7759/cureus.63881 Gage, A. D., Knight, M. A., Bintz, C., Aldridge, R. W., Angelino, O., Dieleman, J. L., Ashworth Dirac, M., Dwyer-Lindgren, L., Hay, S. I., Lozano, R., Mokdad, A. H., & Haakenstad, A. (2025). Disparities in telemedicine use and payment policies in the United States between 2019 and 2023. Communications Medicine, 5(1), 52. https://doi.org/10.1038/s43856-025-00757-2 GemMed. (2025, January 24, 2025). 電子処方箋の導入率、医療機関では2025年3月末でも「1割に届かない」見込み、目標を見直し、診療報酬対応も検討へ—社保審・医療保険部会. GemMed. Retrieved April 8, 2025 from https://gemmed.ghc-j.com/?p=64916 Gullslett, M. K., Ronchi, E., Lundberg, L., Larbi, D., Lind, K. F., Tayefi, M., Ngo, P. D., Sy, T. R., Adib, K., & Hamilton, C. (2024). Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway. Int J Med Inform, 191, 105558. https://doi.org/10.1016/j.ijmedinf.2024.105558 Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117 Hausvik, G. I., & Askedal, K. (2023). Digital Innovation of Healthcare Services in Times of Crisis and Beyond. https://doi.org/10.24251/HICSS.2023.229 Huang, M. G., Fang, H. C., Xu, H. Y., Yeh, M. C., & Li, C. H. (2021). 因應COVID-19台灣遠距醫療應用探討 [Application of telemedicine for COVID-19 in Taiwan]. 醫院雜誌, 54(1), 15-23. Ito, J., Edirippulige, S., Aono, T., & Armfield, N. (2017). The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages. Journal of Telemedicine and Telecare, 23, 828-834. https://doi.org/10.1177/1357633X17732801 Jagarapu, J., & Savani, R. C. (2021). A brief history of telemedicine and the evolution of teleneonatology. Seminars in Perinatology, 45(5), 151416. https://doi.org/https://doi.org/10.1016/j.semperi.2021.151416 Japan Health Policy NOW. (2025). Telemedicine in Japan – A Historical Perspective. Japan Health Policy NOW. https://japanhpn.org/en/ict-1-2/ Kim, M. (2024). 비대면 진료 누적 1032만713건...만성질환자 이용 집중 [Cumulative telemedicine usage reaches 10.32 million cases...Chronic disease patients are primary users]. Medifó News. Retrieved March 17, 2025 from https://www.medifonews.com/news/article.html?no=195296 Kinoshita, S., & Kishimoto, T. (2022). Current Status and Challenges of the Dissemination of Telemedicine in Japan After the Start of the COVID-19 Pandemic. Telemed J E Health, 28(8), 1220-1224. https://doi.org/10.1089/tmj.2021.0336 Kinoshita, S., & Kishimoto, T. (2025). Japan's Telepsychiatry Dissemination: Current Status and Challenges. J Med Internet Res, 27, e22849. https://doi.org/10.2196/22849 Kravitz, R. L. (2010). From the editors' desk: medicine as a service industry. J Gen Intern Med, 25(4), 279. https://doi.org/10.1007/s11606-010-1282-4 Kubota, T., Kuroda, N., Horinouchi, T., Ikegaya, N., Kitazawa, Y., Kodama, S., Kuramochi, I., Matsubara, T., Nagino, N., Neshige, S., Soga, T., Takayama, Y., & Sone, D. (2022). Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan. Epilepsy Behav, 126, 108487. https://doi.org/10.1016/j.yebeh.2021.108487 Lee, C.-C. (2024, August 27). 次世代醫療平台計畫 [Next Generation Medical Platform Project]. https://blog.mohw.gov.tw/459/ Lee, T. L. (2020). Legal preparedness as part of COVID-19 response: the first 100 days in Taiwan. BMJ Glob Health, 5(5). https://doi.org/10.1136/bmjgh-2020-002608 Liu, L. (2024). [Article title in Mandarin]. TVBS. Retrieved from https://news.tvbs.com.tw/life/2531936 Lu, J.-F. R., & and Liang, L.-L. (2024). The Role of Digital Health Under Taiwan’s National Health Insurance System: Progress and Challenges. Health Systems & Reform, 10(2), 2375433. https://doi.org/10.1080/23288604.2024.2375433 Lucas, J. W., & Wang, X. (2024). Declines in Telemedicine Use Among Adults: United States, 2021 and 2022. Natl Health Stat Report(205), 1-11. Mainichi Japan. (2024). Japan maintaining plan to ditch paper health insurance cards for 'My Number' integration. https://mainichi.jp/english/articles/20241003/p2a/00m/0na/011000c Medical Practitioners' Act, Act No. 201 of 1948, amended by Act No. 96 of 2007 (Japan). Japanese Law Translation Database System. https://www.japaneselawtranslation.go.jp/en/laws/view/3992/en Matsuda, S. (2019). Health Policy in Japan – Current Situation and Future Challenges. JMA Journal, 2(1), 1-10. https://doi.org/10.31662/jmaj.2018-0016 MHLW. (2020a). Basic Policies for Novel Coronavirus Disease Control (Tentative translation). Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/10200000/000603610.pdf MHLW. (2020b). Notes on time-limited and exceptional handling of medical care using telephone and information communication devices during the spread of novel coronavirus infection. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/001237021.pdf MHLW. (2020c, April 10). Regarding the time-limited and exceptional handling of medical examinations using telephone and information communication devices with the spread of COVID-19. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/000621247.pdf MHLW. (2023a). Basic Policy for Promoting Online Medical Care and Other Telemedicine. L. a. W. Ministry of Health. https://www.mhlw.go.jp/content/10800000/001116016.pdf MHLW. (2023b). Healthcare DX Promotion Roadmap (Overview). Ministry of Health, Labour and Welfare of Japan Retrieved from https://www.mhlw.go.jp/english/policy/health-medical/healthcare-dx/dl/Healthcare-DX-Promotion-Roadmap(Overview).pdf MHLW. (2023c). Notice regarding the reporting of implementation status and identification of medical institutions for telephone and information communication device-based medical care from initial consultation in the time-limited and exceptional handling of medical care using telephone and information communication devices during the spread of novel coronavirus infection. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/001237670.pdf MHLW. (2023d). Notice Regarding Thorough Compliance with Requirements for Initial Telemedicine Consultations and Reporting of Implementation Status in the Temporary and Exceptional Handling of Telemedicine During the COVID-19 Pandemic. Ministry of Health, Labour and Welfare, Japan Retrieved from http://mhlw.go.jp/content/001237669.pdf MHLW. (2024). Global Health Vision of Ministry of Health, Labour and Welfare of Japan. L. a. W. o. J. Ministry of Health. http://mhlw.go.jp/content/10501000/001295190.pdf MHLW. (2025a). About Health Insurance System. Retrieved May 4, 2025 from https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/koukikourei/index_00002.html MHLW. (2025b). マイナンバーカードの健康保険証利用について [Using My Number Card as Health Insurance Certificate]. https://www.mhlw.go.jp/stf/newpage_08277.html MHLW Medical Affairs Division Health Insurance Bureau. (2022). Overview of the 2022 Medical Fee Revision: Individual Revision Items II (Medical Care Using Information and Communication Devices)]. Ministry of Health, Labour and Welfare Retrieved from https://www.mhlw.go.jp/content/12400000/000911810.pdf MHLW Medical Affairs Division Health Insurance Bureau. (2024). Reiwa 6 Fiscal Year Medical Fee Revision. Ministry of Health, Labour and Welfare Retrieved from https://www.mhlw.go.jp/content/12400000/001251533.pdf MOHW. (2020a). The Centers for Disease Control has announced the establishment of the "Central Epidemic Command Center for Severe Special Infectious Pneumonia" to comprehensively prevent the novel coronavirus pneumonia outbreak from mainland China and to ensure the safety of epidemic prevention in our country. Ministry of Health and Welfare. Retrieved May 3 from https://www.mohw.gov.tw/cp-16-51157-1.html MOHW. (2020b). Ministry of Health and Welfare Medical Letter No. 1091660661. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-002.pdf MOHW. (2020c). Ministry of Health and Welfare Medical Letter No. 1091661115. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-004.pdf MOHW. (2020d). Ministry of Health and Welfare Medical Letter No. 1091661228. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-005.pdf MOHW. (2023). Ministry of Health and Welfare Medical Letter No. 1120661091. Ministry of Health and Welfare Retrieved from https://www.nhi.gov.tw/ch/cp-2295-91a41-3258-1.html MOHW. (2024, January 22). Ministry of Health and Welfare Issues Revised Regulations for Telemedicine Treatment to Improve Medical Accessibility. Retrieved May 2 from https://www.mohw.gov.tw/cp-16-77322-1.html NAGAO, K. (2022). 遠隔診療、そしてオンライン診療の展望 [Prospects for Telemedicine and Online Medical Care]. PSYCHIATRIA ET NEUROLOGIA JAPONICA, 124, 116-125. https://journal.jspn.or.jp/jspn/openpdf/1240020116.pdf Neo Marketing Inc. (2024). Survey on online medical consultations (オンライン診療に関する調査). https://corp.neo-m.jp/service/research/quantitation/netresearch-domestic/ NHIA. (2022). 2022-2023 National Health Insurance Annual Report. M. o. H. a. W. National Health Insurance Administration. https://www.nhi.gov.tw/ch/cp-3153-f49da-2456-1.html NHIA. (2024a). 113年虛擬健保卡推動現況簡介 (Year 113 Virtual Health Insurance Card Implementation Status Introduction). NHIA. (2024b). 全民健康保險遠距醫療給付計畫 [National Health Insurance Telemedicine Payment Plan]. (健保醫字第 1090017665 號 [Health Insurance Medical Letter No. 1090017665]). National Health Insurance Administration Obstfelder, A., Engeseth, K. H., & Wynn, R. (2007). Characteristics of successfully implemented telemedical applications. Implement Sci, 2, 25. https://doi.org/10.1186/1748-5908-2-25 OECD. (2023). The COVID‑19 Pandemic and the Future of Telemedicine (OECD Health Policy Studies, Issue. O. Publishing. https://doi.org/10.1787/ac8b0a27-en Oliveira, T. C. (2020). Bringing health care to the patient: An overview of the use of telemedicine in OECD countries (OECD Health Working Papers, Issue. O. Publishing. https://www.oecd.org/en/publications/bringing-health-care-to-the-patient_8e56ede7-en.html Ooi, L. C., & Mei, L. Y. (2025). Beyond the Pandemic: TELEHEALTH. SMA News, 12-13. https://www.sma.org.sg/UploadedImg/1744601441_2025MarOpinion.pdf Physician Act, Republic of China Act No. L0020001 art. 11 (1943, amended 2025). Laws & Regulations Database of the Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020001&flno=11 Satoshi Ogawa, Yuto Noro, Hitoshi Fujimaki, & Saito, S. (2024, June 27). Digital Healthcare 2024. https://practiceguides.chambers.com/practice-guides/digital-healthcare-2024/japan/trends-and-developments Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare, 24(1), 4-12. https://doi.org/10.1177/1357633x16674087 Shigekoto, K. (1998). 1. 日本における遠隔医療の実現について. 映像情報メディア学会誌, 52(9), 1244-1246. https://doi.org/10.3169/itej.52.1244 Sugawara, Y., Hirakawa, Y., Iwagami, M., Kuroki, H., Mitani, S., Inagaki, A., Ohashi, H., Kubota, M., Koike, S., Wakimizu, R., & Nangaku, M. (2024). Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey. J Med Internet Res, 26, e64159. https://doi.org/10.2196/64159 Taipei City Government. (2020). Taipei City. One Hundred Years: Back to 1920 (Taipei Yearbook, Issue. https://tpml.gov.taipei/News_Content.aspx?n=E91BF58F2D71B67A&sms=53A088FE07608516&s=481D1D7CF831F2DC Taiwan Centers for Disease Control. (2023). 因應防疫鬆綁新制，自3月20日起調整COVID-19遺體處置感染管制建議 [Responding to new epidemic prevention relaxation measures, adjusting infection control recommendations for COVID-19 corpse handling starting from March 20]. Retrieved 2025 from https://www.cdc.gov.tw/Category/ListContent/EmXemht4IT-IRAPrAnyG9A?uaid=39Jge0updnN0pVxaANwpjw Taiwan Ministry of Health and Welfare. (2018, May 11). Regulations on telemedicine consultation and treatment (通訊診察治療辦法) [Regulation]. Laws & Regulations Database of The Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawOldVer.aspx?pcode=L0020197&lnndate=20180511&lser=001 The ITU Association of Japan. (2021). 50th Anniversary of the ITU Association of Japan (New Breeze 2021 Autumn, Issue. T. Yamakawa. https://www.ituaj.jp/wp-content/uploads/2021/10/nb33-4_web5_Special-Feature_Expansion-of-Telemedicine-in-the-Wake-of-the-COVID-19-Pandemic.pdf U.S. Chamber of Commerce International Affairs. (2025). Digitalization Delivers: Japan's Digital Health Transformation and Optimizing Patient Health Outcomes through a U.S.-Japan Partnership. Wakimizu, R., Kuroki, H., Ohbayashi, K., Ohashi, H., Yamaoka, K., Sonoda, A., & Muto, S. (2021). Perceptions and Attitudes Toward Telemedicine by Clinicians and Patients in Japan During the COVID-19 Pandemic. Telemed Rep, 2(1), 197-204. https://doi.org/10.1089/tmr.2021.0012 Wen, H.-C., Chang, W., Hsu, M.-H., Ho, C.-H., & Chu, C.-M. (2018). An assessment of the interoperability of electronic health record exchanges among hospitals and clinics in Taiwan (Preprint). JMIR Medical Informatics, 7. https://doi.org/10.2196/12630 Wu, T. C., & Ho, C. B. (2023). Barriers to Telemedicine Adoption during the COVID-19 Pandemic in Taiwan: Comparison of Perceived Risks by Socioeconomic Status Correlates. Int J Environ Res Public Health, 20(4). https://doi.org/10.3390/ijerph20043504 Yamada, A., & Wada, N. (2022, June 09). A quick regulatory guide to telehealth services in Japan. Healthcare IT News. https://www.healthcareitnews.com/news/asia/quick-regulatory-guide-telehealth-services-japan Yasuda, T., Iwai, N., Yi, C.-c., & Xie, G. (2011). Intergenerational Coresidence in China, Japan, South Korea and Taiwan: Comparative Analyses Based on the East Asian Social Survey 2006. Journal of Comparative Family Studies, 42(5), 703-722. http://www.jstor.org/stable/41604480 大江和彦. (2020). HL7FHIRとそれにもとづく医療文書標準仕様の策定 [HL7 FHIR and development of medical document standard specifications based on it] [PowerPoint presentation]. https://www.mhlw.go.jp/content/12600000/000685282.pdf 李伯璋, 許明暉, 蕭乃彰, 劉文琪, 陳潤秋, 楊時豪, 李偉強, 余尚儒, 吳漢章, & 徐業良. (2023). 發展遠距醫療健康照護的挑戰與策略 [Challenges and strategies for developing telemedicine and health care]. C. Foundation. https://www.ctci.org.tw/media/9836/2023-06-%E7%99%BC%E5%B1%95%E9%81%A0%E8%B7%9D%E9%86%AB%E7%99%82%E5%81%A5%E5%BA%B7%E7%85%A7%E8%AD%B7%E7%9A%84%E6%8C%91%E6%88%B0%E8%88%87%E7%AD%96%E7%95%A5.pdf 石崇良. (2024). 台灣遠距醫療的推動與展望 [The promotion and prospects of telemedicine in Taiwan] [PowerPoint presentation]. 描述 碩士
國立政治大學
應用經濟與社會發展英語碩士學位學程(IMES)
112266001資料來源 http://thesis.lib.nccu.edu.tw/record/#G0112266001 資料類型 thesis dc.contributor.advisor 連賢明 zh_TW dc.contributor.advisor Lien, Hsien-Ming en_US dc.contributor.author (Authors) 潘立珊 zh_TW dc.contributor.author (Authors) Pan, Li-Shan en_US dc.creator (作者) 潘立珊 zh_TW dc.creator (作者) Pan, Li-Shan en_US dc.date (日期) 2025 en_US dc.date.accessioned 1-Jul-2025 15:10:53 (UTC+8) - dc.date.available 1-Jul-2025 15:10:53 (UTC+8) - dc.date.issued (上傳時間) 1-Jul-2025 15:10:53 (UTC+8) - dc.identifier (Other Identifiers) G0112266001 en_US dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/157816 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 應用經濟與社會發展英語碩士學位學程(IMES) zh_TW dc.description (描述) 112266001 zh_TW dc.description.abstract (摘要) COVID-19疫情在全球催化了前所未有的遠距醫療採用，然而到2023-2024年，日本和台灣的使用率均已回落接近至疫情前水平。本研究透過分析政策演變、系統設備和使用者因素，探討兩個技術先進醫療體系中後疫情時代遠距醫療使用率下降的因素。本研究採用2018-2024年醫療政策和全國使用率數據的文件分析，並輔以台灣醫療專業人員的訪談，調查遠距醫療成長為何無法持續。研究結論指出，不同的政策轉型策略導致了相似的結果，顯示遠距醫療採用面臨超越監管方法的結構性挑戰。未來的整合可能需要混合模式，在承認醫療互動的具身性本質的同時，善用科技的可及性優勢。 zh_TW dc.description.abstract (摘要) The COVID-19 pandemic catalyzed unprecedented telemedicine adoption across East Asia, yet by 2023-2024, usage rates in both Japan and Taiwan had declined to pre- pandemic levels. This comparative study examines factors contributing to this post- pandemic decline through analysis of policy evolution, system implementation, and user adoption patterns in two technologically advanced healthcare systems. Using document analysis of healthcare policies and national utilization data from 2018-2024, national utilization data supplemented by interviews with Taiwanese healthcare professionals, this research investigates why telemedicine gains proved unsustainable. Key findings reveal Japan's graduated policy approach maintained telemedicine reimbursement at 87% of in-person rates, creating financial disincentives. Taiwan's "reset-and-rebuild" strategy restricted coverage to specialized populations. Both countries faced technical challenges, including low digital identity adoption and legacy system integration difficulties. Interview findings demonstrate that Taiwanese healthcare professionals maintain low preference for telemedicine due to concerns about clinical assessment limitations and disrupted trust-building mechanisms in virtual environments. The research concludes that different policy transition strategies led to similar outcomes, suggesting telemedicine adoption in East Asian contexts faces structural challenges transcending regulatory approaches. Future integration requires hybrid models that acknowledge the embodied nature of medical interactions while leveraging technology's accessibility benefits of technology. en_US dc.description.tableofcontents 1. Introduction 1 1.1 Background& Motivation 1 Chapter 2 Conceptual Framework and Literature Review 9 2.1 Comparative Definitions for Japan and Taiwan 9 2.2 The Uniqueness of Medical Interactions 10 2.3 Historical development 11 2.3.1 Historical development of Japan 11 2.3.2 Historical development of Taiwan 13 2.4 Review of Telemedicine during COVID-19 14 Chapter 3: Analysis of Policy Changes and Implementation 16 3.1 Japan's Telemedicine Policy Evolution 16 3.1.1 COVID-era Emergency Measures 16 3.1.2 Post-COVID Policy Adjustments 19 3.2 Taiwan's Telemedicine Policy Evolution 20 3.2.1 COVID-era Emergency Measures 20 3.2.2 Post-COVID Policy Adjustments 24 3.3 Comparative Analysis of Policy Exit Strategies 25 Chapter 4 Research Methodology 28 4.1 Research Design Rationale 28 4.2 Interview design 29 Chapter 5 Analysis of Usage Decline Factors 32 5.1 Policy-related factors 32 5.1.1 Japan: Persistent Payment Gap and Economic Barriers 32 5.1.2 Taiwan: Dual Restrictions on Targets and Scope of Coverage 34 5.1.2.1 Official Policy vs. Implementation Reality 35 5.2 System-related factors 37 5.2.1 Emergency Systems versus Sustainable Infrastructure 37 5.2.2 Current Status and Challenges of Data Exchange Standards 38 5.2.3 Digital Identity and Authentication Challenges 40 5.3 User-related Factors 42 5.3.1 Trust Formation and Clinical Assessment in Medical Encounters 42 5.3.1.1 Specialty-Specific Telemedicine Adoption Patterns 44 5.3.2 Sociodemographic Factors 46 5.4 Cross-Country Analysis of Telemedicine Adoption Barriers 50 Chapter 6: Conclusion & Discussion 52 Reference List 55 zh_TW dc.format.extent 1809552 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0112266001 en_US dc.subject (關鍵詞) 遠距醫療 zh_TW dc.subject (關鍵詞) 遠距健康 zh_TW dc.subject (關鍵詞) COVID-19 zh_TW dc.subject (關鍵詞) 後疫情 zh_TW dc.subject (關鍵詞) 視訊門診 zh_TW dc.subject (關鍵詞) 遠距照護 zh_TW dc.subject (關鍵詞) telemedicine en_US dc.subject (關鍵詞) telehealth en_US dc.subject (關鍵詞) COVID-19 en_US dc.subject (關鍵詞) post-pandemic en_US dc.subject (關鍵詞) healthcare policy en_US dc.subject (關鍵詞) digital health en_US dc.title (題名) 後疫情時代遠距醫療使用率下降之比較分析--台灣與日本之政策、實施與使用者因素 zh_TW dc.title (題名) Post-COVID Telemedicine Usage Decline: A Comparative Analysis of Policy, Implementation, and User Factors in Taiwan and Japan en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) Akiyama, M., & Yoo, B. K. (2016). A Systematic Review of the Economic Evaluation of Telemedicine in Japan. J Prev Med Public Health, 49(4), 183-196. https://doi.org/10.3961/jpmph.16.043 Aung, M. N., Koyanagi, Y., Nagamine, Y., Nam, E. W., Mulati, N., Kyaw, M. Y., Moolphate, S., Shirayama, Y., Nonaka, K., Field, M., Cheung, P., & Yuasa, M. (2022). Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand. Int J Environ Res Public Health, 19(12). https://doi.org/10.3390/ijerph19126976 Cabinet Office, G. o. J. (2021). 規制改革実施計画 [Regulatory Reform Implementation Plan]. Retrieved from https://www8.cao.go.jp/kisei-kaikaku/kisei/publication/keikaku/210618/keikaku.pdf CECC. (2020). 肺中指字第1093800108號. Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081049700-1120323-1000-003.pdf Chiu, K. H., & Yang, Y. Y. (2010). Remote monitoring of health status of the elderly at home in Taiwan. Telemed J E Health, 16(6), 717-726. https://doi.org/10.1089/tmj.2010.0006 Ezeamii, V. C., Okobi, O. E., Wambai-Sani, H., Perera, G. S., Zaynieva, S., Okonkwo, C. C., Ohaiba, M. M., William-Enemali, P. C., Obodo, O. R., & Obiefuna, N. G. (2024). Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus, 16(7), e63881. https://doi.org/10.7759/cureus.63881 Gage, A. D., Knight, M. A., Bintz, C., Aldridge, R. W., Angelino, O., Dieleman, J. L., Ashworth Dirac, M., Dwyer-Lindgren, L., Hay, S. I., Lozano, R., Mokdad, A. H., & Haakenstad, A. (2025). Disparities in telemedicine use and payment policies in the United States between 2019 and 2023. Communications Medicine, 5(1), 52. https://doi.org/10.1038/s43856-025-00757-2 GemMed. (2025, January 24, 2025). 電子処方箋の導入率、医療機関では2025年3月末でも「1割に届かない」見込み、目標を見直し、診療報酬対応も検討へ—社保審・医療保険部会. GemMed. Retrieved April 8, 2025 from https://gemmed.ghc-j.com/?p=64916 Gullslett, M. K., Ronchi, E., Lundberg, L., Larbi, D., Lind, K. F., Tayefi, M., Ngo, P. D., Sy, T. R., Adib, K., & Hamilton, C. (2024). Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway. Int J Med Inform, 191, 105558. https://doi.org/10.1016/j.ijmedinf.2024.105558 Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117 Hausvik, G. I., & Askedal, K. (2023). Digital Innovation of Healthcare Services in Times of Crisis and Beyond. https://doi.org/10.24251/HICSS.2023.229 Huang, M. G., Fang, H. C., Xu, H. Y., Yeh, M. C., & Li, C. H. (2021). 因應COVID-19台灣遠距醫療應用探討 [Application of telemedicine for COVID-19 in Taiwan]. 醫院雜誌, 54(1), 15-23. Ito, J., Edirippulige, S., Aono, T., & Armfield, N. (2017). The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages. Journal of Telemedicine and Telecare, 23, 828-834. https://doi.org/10.1177/1357633X17732801 Jagarapu, J., & Savani, R. C. (2021). A brief history of telemedicine and the evolution of teleneonatology. Seminars in Perinatology, 45(5), 151416. https://doi.org/https://doi.org/10.1016/j.semperi.2021.151416 Japan Health Policy NOW. (2025). Telemedicine in Japan – A Historical Perspective. Japan Health Policy NOW. https://japanhpn.org/en/ict-1-2/ Kim, M. (2024). 비대면 진료 누적 1032만713건...만성질환자 이용 집중 [Cumulative telemedicine usage reaches 10.32 million cases...Chronic disease patients are primary users]. Medifó News. Retrieved March 17, 2025 from https://www.medifonews.com/news/article.html?no=195296 Kinoshita, S., & Kishimoto, T. (2022). Current Status and Challenges of the Dissemination of Telemedicine in Japan After the Start of the COVID-19 Pandemic. Telemed J E Health, 28(8), 1220-1224. https://doi.org/10.1089/tmj.2021.0336 Kinoshita, S., & Kishimoto, T. (2025). Japan's Telepsychiatry Dissemination: Current Status and Challenges. J Med Internet Res, 27, e22849. https://doi.org/10.2196/22849 Kravitz, R. L. (2010). From the editors' desk: medicine as a service industry. J Gen Intern Med, 25(4), 279. https://doi.org/10.1007/s11606-010-1282-4 Kubota, T., Kuroda, N., Horinouchi, T., Ikegaya, N., Kitazawa, Y., Kodama, S., Kuramochi, I., Matsubara, T., Nagino, N., Neshige, S., Soga, T., Takayama, Y., & Sone, D. (2022). Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan. Epilepsy Behav, 126, 108487. https://doi.org/10.1016/j.yebeh.2021.108487 Lee, C.-C. (2024, August 27). 次世代醫療平台計畫 [Next Generation Medical Platform Project]. https://blog.mohw.gov.tw/459/ Lee, T. L. (2020). Legal preparedness as part of COVID-19 response: the first 100 days in Taiwan. BMJ Glob Health, 5(5). https://doi.org/10.1136/bmjgh-2020-002608 Liu, L. (2024). [Article title in Mandarin]. TVBS. Retrieved from https://news.tvbs.com.tw/life/2531936 Lu, J.-F. R., & and Liang, L.-L. (2024). The Role of Digital Health Under Taiwan’s National Health Insurance System: Progress and Challenges. Health Systems & Reform, 10(2), 2375433. https://doi.org/10.1080/23288604.2024.2375433 Lucas, J. W., & Wang, X. (2024). Declines in Telemedicine Use Among Adults: United States, 2021 and 2022. Natl Health Stat Report(205), 1-11. Mainichi Japan. (2024). Japan maintaining plan to ditch paper health insurance cards for 'My Number' integration. https://mainichi.jp/english/articles/20241003/p2a/00m/0na/011000c Medical Practitioners' Act, Act No. 201 of 1948, amended by Act No. 96 of 2007 (Japan). Japanese Law Translation Database System. https://www.japaneselawtranslation.go.jp/en/laws/view/3992/en Matsuda, S. (2019). Health Policy in Japan – Current Situation and Future Challenges. JMA Journal, 2(1), 1-10. https://doi.org/10.31662/jmaj.2018-0016 MHLW. (2020a). Basic Policies for Novel Coronavirus Disease Control (Tentative translation). Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/10200000/000603610.pdf MHLW. (2020b). Notes on time-limited and exceptional handling of medical care using telephone and information communication devices during the spread of novel coronavirus infection. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/001237021.pdf MHLW. (2020c, April 10). Regarding the time-limited and exceptional handling of medical examinations using telephone and information communication devices with the spread of COVID-19. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/000621247.pdf MHLW. (2023a). Basic Policy for Promoting Online Medical Care and Other Telemedicine. L. a. W. Ministry of Health. https://www.mhlw.go.jp/content/10800000/001116016.pdf MHLW. (2023b). Healthcare DX Promotion Roadmap (Overview). Ministry of Health, Labour and Welfare of Japan Retrieved from https://www.mhlw.go.jp/english/policy/health-medical/healthcare-dx/dl/Healthcare-DX-Promotion-Roadmap(Overview).pdf MHLW. (2023c). Notice regarding the reporting of implementation status and identification of medical institutions for telephone and information communication device-based medical care from initial consultation in the time-limited and exceptional handling of medical care using telephone and information communication devices during the spread of novel coronavirus infection. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/content/001237670.pdf MHLW. (2023d). Notice Regarding Thorough Compliance with Requirements for Initial Telemedicine Consultations and Reporting of Implementation Status in the Temporary and Exceptional Handling of Telemedicine During the COVID-19 Pandemic. Ministry of Health, Labour and Welfare, Japan Retrieved from http://mhlw.go.jp/content/001237669.pdf MHLW. (2024). Global Health Vision of Ministry of Health, Labour and Welfare of Japan. L. a. W. o. J. Ministry of Health. http://mhlw.go.jp/content/10501000/001295190.pdf MHLW. (2025a). About Health Insurance System. Retrieved May 4, 2025 from https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/koukikourei/index_00002.html MHLW. (2025b). マイナンバーカードの健康保険証利用について [Using My Number Card as Health Insurance Certificate]. https://www.mhlw.go.jp/stf/newpage_08277.html MHLW Medical Affairs Division Health Insurance Bureau. (2022). Overview of the 2022 Medical Fee Revision: Individual Revision Items II (Medical Care Using Information and Communication Devices)]. Ministry of Health, Labour and Welfare Retrieved from https://www.mhlw.go.jp/content/12400000/000911810.pdf MHLW Medical Affairs Division Health Insurance Bureau. (2024). Reiwa 6 Fiscal Year Medical Fee Revision. Ministry of Health, Labour and Welfare Retrieved from https://www.mhlw.go.jp/content/12400000/001251533.pdf MOHW. (2020a). The Centers for Disease Control has announced the establishment of the "Central Epidemic Command Center for Severe Special Infectious Pneumonia" to comprehensively prevent the novel coronavirus pneumonia outbreak from mainland China and to ensure the safety of epidemic prevention in our country. Ministry of Health and Welfare. Retrieved May 3 from https://www.mohw.gov.tw/cp-16-51157-1.html MOHW. (2020b). Ministry of Health and Welfare Medical Letter No. 1091660661. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-002.pdf MOHW. (2020c). Ministry of Health and Welfare Medical Letter No. 1091661115. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-004.pdf MOHW. (2020d). Ministry of Health and Welfare Medical Letter No. 1091661228. Ministry of Health and Welfare Retrieved from https://www.rootlaw.com.tw/Attach/L-Doc/A040170081048700-1090227-1000-005.pdf MOHW. (2023). Ministry of Health and Welfare Medical Letter No. 1120661091. Ministry of Health and Welfare Retrieved from https://www.nhi.gov.tw/ch/cp-2295-91a41-3258-1.html MOHW. (2024, January 22). Ministry of Health and Welfare Issues Revised Regulations for Telemedicine Treatment to Improve Medical Accessibility. Retrieved May 2 from https://www.mohw.gov.tw/cp-16-77322-1.html NAGAO, K. (2022). 遠隔診療、そしてオンライン診療の展望 [Prospects for Telemedicine and Online Medical Care]. PSYCHIATRIA ET NEUROLOGIA JAPONICA, 124, 116-125. https://journal.jspn.or.jp/jspn/openpdf/1240020116.pdf Neo Marketing Inc. (2024). Survey on online medical consultations (オンライン診療に関する調査). https://corp.neo-m.jp/service/research/quantitation/netresearch-domestic/ NHIA. (2022). 2022-2023 National Health Insurance Annual Report. M. o. H. a. W. National Health Insurance Administration. https://www.nhi.gov.tw/ch/cp-3153-f49da-2456-1.html NHIA. (2024a). 113年虛擬健保卡推動現況簡介 (Year 113 Virtual Health Insurance Card Implementation Status Introduction). NHIA. (2024b). 全民健康保險遠距醫療給付計畫 [National Health Insurance Telemedicine Payment Plan]. (健保醫字第 1090017665 號 [Health Insurance Medical Letter No. 1090017665]). National Health Insurance Administration Obstfelder, A., Engeseth, K. H., & Wynn, R. (2007). Characteristics of successfully implemented telemedical applications. Implement Sci, 2, 25. https://doi.org/10.1186/1748-5908-2-25 OECD. (2023). The COVID‑19 Pandemic and the Future of Telemedicine (OECD Health Policy Studies, Issue. O. Publishing. https://doi.org/10.1787/ac8b0a27-en Oliveira, T. C. (2020). Bringing health care to the patient: An overview of the use of telemedicine in OECD countries (OECD Health Working Papers, Issue. O. Publishing. https://www.oecd.org/en/publications/bringing-health-care-to-the-patient_8e56ede7-en.html Ooi, L. C., & Mei, L. Y. (2025). Beyond the Pandemic: TELEHEALTH. SMA News, 12-13. https://www.sma.org.sg/UploadedImg/1744601441_2025MarOpinion.pdf Physician Act, Republic of China Act No. L0020001 art. 11 (1943, amended 2025). Laws & Regulations Database of the Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020001&flno=11 Satoshi Ogawa, Yuto Noro, Hitoshi Fujimaki, & Saito, S. (2024, June 27). Digital Healthcare 2024. https://practiceguides.chambers.com/practice-guides/digital-healthcare-2024/japan/trends-and-developments Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare, 24(1), 4-12. https://doi.org/10.1177/1357633x16674087 Shigekoto, K. (1998). 1. 日本における遠隔医療の実現について. 映像情報メディア学会誌, 52(9), 1244-1246. https://doi.org/10.3169/itej.52.1244 Sugawara, Y., Hirakawa, Y., Iwagami, M., Kuroki, H., Mitani, S., Inagaki, A., Ohashi, H., Kubota, M., Koike, S., Wakimizu, R., & Nangaku, M. (2024). Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey. J Med Internet Res, 26, e64159. https://doi.org/10.2196/64159 Taipei City Government. (2020). Taipei City. One Hundred Years: Back to 1920 (Taipei Yearbook, Issue. https://tpml.gov.taipei/News_Content.aspx?n=E91BF58F2D71B67A&sms=53A088FE07608516&s=481D1D7CF831F2DC Taiwan Centers for Disease Control. (2023). 因應防疫鬆綁新制，自3月20日起調整COVID-19遺體處置感染管制建議 [Responding to new epidemic prevention relaxation measures, adjusting infection control recommendations for COVID-19 corpse handling starting from March 20]. Retrieved 2025 from https://www.cdc.gov.tw/Category/ListContent/EmXemht4IT-IRAPrAnyG9A?uaid=39Jge0updnN0pVxaANwpjw Taiwan Ministry of Health and Welfare. (2018, May 11). Regulations on telemedicine consultation and treatment (通訊診察治療辦法) [Regulation]. Laws & Regulations Database of The Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawOldVer.aspx?pcode=L0020197&lnndate=20180511&lser=001 The ITU Association of Japan. (2021). 50th Anniversary of the ITU Association of Japan (New Breeze 2021 Autumn, Issue. T. Yamakawa. https://www.ituaj.jp/wp-content/uploads/2021/10/nb33-4_web5_Special-Feature_Expansion-of-Telemedicine-in-the-Wake-of-the-COVID-19-Pandemic.pdf U.S. Chamber of Commerce International Affairs. (2025). Digitalization Delivers: Japan's Digital Health Transformation and Optimizing Patient Health Outcomes through a U.S.-Japan Partnership. Wakimizu, R., Kuroki, H., Ohbayashi, K., Ohashi, H., Yamaoka, K., Sonoda, A., & Muto, S. (2021). Perceptions and Attitudes Toward Telemedicine by Clinicians and Patients in Japan During the COVID-19 Pandemic. Telemed Rep, 2(1), 197-204. https://doi.org/10.1089/tmr.2021.0012 Wen, H.-C., Chang, W., Hsu, M.-H., Ho, C.-H., & Chu, C.-M. (2018). An assessment of the interoperability of electronic health record exchanges among hospitals and clinics in Taiwan (Preprint). JMIR Medical Informatics, 7. https://doi.org/10.2196/12630 Wu, T. C., & Ho, C. B. (2023). Barriers to Telemedicine Adoption during the COVID-19 Pandemic in Taiwan: Comparison of Perceived Risks by Socioeconomic Status Correlates. Int J Environ Res Public Health, 20(4). https://doi.org/10.3390/ijerph20043504 Yamada, A., & Wada, N. (2022, June 09). A quick regulatory guide to telehealth services in Japan. Healthcare IT News. https://www.healthcareitnews.com/news/asia/quick-regulatory-guide-telehealth-services-japan Yasuda, T., Iwai, N., Yi, C.-c., & Xie, G. (2011). Intergenerational Coresidence in China, Japan, South Korea and Taiwan: Comparative Analyses Based on the East Asian Social Survey 2006. Journal of Comparative Family Studies, 42(5), 703-722. http://www.jstor.org/stable/41604480 大江和彦. (2020). HL7FHIRとそれにもとづく医療文書標準仕様の策定 [HL7 FHIR and development of medical document standard specifications based on it] [PowerPoint presentation]. https://www.mhlw.go.jp/content/12600000/000685282.pdf 李伯璋, 許明暉, 蕭乃彰, 劉文琪, 陳潤秋, 楊時豪, 李偉強, 余尚儒, 吳漢章, & 徐業良. (2023). 發展遠距醫療健康照護的挑戰與策略 [Challenges and strategies for developing telemedicine and health care]. C. Foundation. https://www.ctci.org.tw/media/9836/2023-06-%E7%99%BC%E5%B1%95%E9%81%A0%E8%B7%9D%E9%86%AB%E7%99%82%E5%81%A5%E5%BA%B7%E7%85%A7%E8%AD%B7%E7%9A%84%E6%8C%91%E6%88%B0%E8%88%87%E7%AD%96%E7%95%A5.pdf 石崇良. (2024). 台灣遠距醫療的推動與展望 [The promotion and prospects of telemedicine in Taiwan] [PowerPoint presentation]. zh_TW
