智慧城市的健康承諾：智慧醫療生態系與臺灣長期照顧服務在地化挑戰【月旦時論】 試閱
The Health Promise of Smart Cities: Smart Healthcare Ecosystems and the Challenges of Long-term Care Localization in Taiwan
本文旨在確立「關係導向式智慧醫療城市」的核心概念，區辨其與傳統醫療數位化在治理邏輯上的根本差異，並將智慧醫療社群視為一種以去中心化協作為基底的醫療關係重組框架。在全球高齡化與少子化導致人口下降、稅基萎縮，並威脅社會福利與公共建設財源的衝擊之下，臺灣長期照顧服務（下稱長照）在地化亦面臨「服務模式過度依賴傳統人力」、「遠距醫療法規侷限」與「醫療資訊系統整合不足」三項實務困境。本文提出法制與治理視角分析，研究論證若臺灣欲真正邁向以人為本的智慧城市，必須優先完成法規調適，並建構「社區核心醫師」制度、擴大通訊診療適用性，以及建置「流動式醫療人力共享機制」等改革藍圖，使智慧醫療得以深度嵌入在地健康與長照系統之中，以回應高齡化與少子化社會的迫切挑戰。
This paper aims to establish the core concept of the “Relation-Oriented Smart Health City,” highlighting its fundamental divergence in governance logic from traditional healthcare digitalization. It regards the Smart Healthcare Community (SHC) as a framework for reorganizing medical relationships through decentralized collaboration. Due to global aging and low birth rates leading to population decline, the erosion of the tax base, and threats to social welfare and public funding for infrastructure, Taiwan’s localized long-term care sector faces three key practical challenges: “over-reliance on traditional manpower service models,” “regulatory restrictions on telemedicine, “and” insufficient integration of medical information systems.” Analyzing the issue from legal and governance perspectives, this study argues that if Taiwan truly aims to transition toward a people-centered smart city, it must prioritize regulatory adaptation and alignment, thus developing blueprints such as the establishment of a ‘Community Core Physician’ system, the expansion of the scope of remote consultation and treatment, and the implementation of a “Shared Mobile Healthcare Workforce Mechanism”. These initiatives will help embed smart healthcare deeply within local health and long-term care systems, addressing the critical challenges of an aging society with low birth rates.
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