http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/204 2026-04-05T03:30:19Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46107 標題: Ｔ質子治療中心營運可行性推估; Evaluation of Operation of Proton Therapy Center 作者: Hon-Man Liu; 廖漢文 摘要: 癌症在近年來已成為台灣最重要的疾病及人死亡原因之首。隨著科技進步許多新穎的癌症治療方式及藥物不斷的發明及採用。但放射線治療仍為主要治療癌症的方式之一。傳統放射線治療最大缺點是會傷及正常組織及不能全部能量加褚癌病灶上。所以治療上會發生不少後遺症或容易復發。基本上，質子治療針對傳統放射線治療的上述兩大缺點具有其特別優勢。但由於質子治療系統造價昂貴，相關配備及硬體設置也較傳統放射線治療成本增加很多，所以台灣遲遲未有質子治療的成立。 在未來二至三年內，台灣會有兩個質子治療中心相繼成立。本研究主要針對Ｔ質子治療中心的特性(硬體由外界捐贈)，公家機構營運，以及沒有前例可循的情況下，作出各種不同的分析推算。 文中首先針對質子治療的歷史，質子治療的物理與生物基礎及目前全球質子治療的現況作簡單扼要的介紹。然後依文獻報告了解目前質子治療的適應症，以作為研究中討論的參考。 雖以Ｔ質子治療中心乃以捐贈為主，但是由於涉及日後營運維護成本，所以在成本分析中仍要計算儀器及建築成本等。文中依國外資料參考推估建造一個有5個治療房(含3 gantry+2 fixed beam)的質子治療中心建置總成立約為台幣五十億。而營運成本方面，最主要討論人事成本，公用事務成本，設備管理維護與服務成本，設備與工程整修費用折舊，作業及行政管理費用的成本，以一般計算方式。Ｔ質子治療中心在第三年以後要自行負擔設備管理維護費用，所以成本會突然高漲。此外，其中最重要是指出所謂fraction的成本概念，主要原因是美國，和歐洲目前針對質子治療的支付都是以fraction為給付單位。質子治療隨著不同方法和疾病有不同的治療量及方式，每個病患接受的fraction數目，可以從1個到40個或以上，而每個fraction的照野次數及方式也不一定相同。 所以依文獻說明假定以平均每位病人接受25fraction為整體質子治療的數量。研究中也指出影響fraction的單位成最主要的因素分別為工作時間，start-up與turn-down time，up-time的百分比及名目治療時間(正式治療時使用質子的時間加上每fraction前準備時間)，研究中針對上述因素作出敏感分析。 針對未來質子治療收入部份，研究中也以fraction為單位，參考目前台灣，美國，日本，瑞士的傳統放射線，立體定位放射線治療與質子治療的給付情況，作出合理的推算，未來合理的質子治療給付為每fraction，合台幣20,928。以上針對前面所得結果，推算Ｔ質子治療中心的營運財務情況。爾後，就治療費用人員營運成熟度，及每年工作時數作出不同敏感分析，針對淨現值與內部報酬率作出試算。 結果顯示其中影響最大是每年工作時數(名目治療時間)，對淨現值與內部報酬率，從每週上班六天，工作十六小時變成每週上班五天，工作十二小時兩值均有60~70%的影響，而以名目治療時間分析發現，工作人員營運成熟度影響較小約為3~5%，治療費用如從每fraction台幣20,000元降為15,000元時，淨現值也會有7%的變動，而內部報酬率變動較小。 最後討論其他對質子治療中心營運可能影響因素。 就全國病人數目而言，目前依質子治療的適應症Ｔ質子治療中心未來是有很大發展空間，但必需配合工作時數，相關人力與人才培育，使早日有達到完全營運狀況。此外，要靠智慧型的排程及人員成熟度來減輕病人複雜度對營運的影響。建議提出聘僱相關重要人力是重要的一環。研究中也指出semi-fixed cost在放射線治療以及質子治療同屬重要，日後經營也必然要多作考量。也討論到外在影響如Open system，政府政策，Ｃ醫院的定價策略，捐贈單位的長期補助與否等。最後提出國際醫療的可行性。; Recently, cancer has become one of most important diseases and also the first leading cause of death in Taiwan. Though there are many newly developed medication and implementation of many innovative treatments, radiotherapy still play an important role in cancer treatment. Damage to normal tissue and cannot put all the energy into the lesions are the major disadvantages of conventional radiotherapy. These make radiotherapy can cause sequelae and recurrence occasionally. Proton therapy has the advantage over conventional radiotherapy to avoid the damage of normal tissue during the treatment and put almost all the energy to the designed lesion location. However, it is very expensive to build an integrate proton treatment system and cost of each proton treatment is much higher than the conventional radiotherapy. In the next few years, two proton treatment centers will start to operate. In this research, we try to analysis the operation of T proton treatment center which is characterized by the aspect of public center donated by private funds, run by government owned university, and without local reference. In the first part of this study, the history of proton treatment, its physical and biological basis in treatment of cancer, the current status of proton therapy in the world, and the indication of proton treatment were briefly reviewed. A private fund donated all the major hardware to the T proton treatment center, but this fix cost was closely related to operation cost in the future, so the construction cost and equipment cost was also calculated according to references. All the calculation will be set upon a presumption that the T proton treatment center will have 3 gantries and 2 fixed beam treatment rooms and costs about NT$ 5,000,000,000 (construction cost + equipment cost). In the terms of operation cost, we discussed the personnel cost, cost of utilization, cost of management and maintenance, deprivation, cost of operation and administration according to the traditional way in T hospital. Three years after the installation, the total operation cost will be rising suddenly due to cost of management and maintenance. Most of all, the cost of fraction in treatment is the key factor. In the USA and Europe, the unit of reimbursement in proton treatment is “fraction”. In different disease and different location, the use of proton therapy will be different. This means the number of fraction of each treatment in different patient will be not the same. One patient may receive one fraction (stereotactic radiosurgery) to more than 40 fractions in one course of proton treatment. Even, the number of portal is different in each fraction also. In this study, the assumption is a total of 25 fractions will be averagely delivered to every patient. The important factors that impact the fraction are working hours, start-up and turn-down time, nominal treatment time(time for preparation and using proton beam in each fraction). The sensitivity analysis was done for these factors too. Working hours is the key factor effect the cost of fraction. Regarding to revenue, fraction is also the unit of income. With reference to the data from USA, Japan, and Swiss and the ratio of payment to stereotactic radiosurgery and proton treatment in these 3 countries, the reimbursement of each fraction can be predict to be NT$20,928. With all these results, we can evaluate the operational financials in NTU proton treatment center. Sensitivity analysis of net present value and IRR with the variants such as maturity of person performance, nominal treatment time, and working hours were also performed. Working hours and nominal treatment time are the two key factors to net present value and IRR. If the schedule is working 6 days a week and 16 hours a day, that will be a remarkable increase in both values as compare to a schedule of working 5 days a week and 12 hours a day. The percentile of change is about 3%-5% in the variant of maturity of person performance, and it is about 7% change in NPV but minimum in IRR if the reimbursement decreased from NT$20,000 to NT$15,000. The study found that the new cancer patient that can be the candidates using proton therapy is far more than the capacity of the 2 new proton treatment centers in Taiwan. If T proton treatment center can provide enough working hours for treatment, accelerate the maturity of staffs, the fully operation of whole system can be foreseen in a short time. However, this also acquires intelligent scheduling to relief the problem of patient-mixed. Early appointment of key leading person such as director and medical physicists is also important. The concept of semi-fixed cost is important in conventional radiotherapy as well as proton treatment center. Other factors such as open system, governmental policy, the pricing of C hospital, the support from private funds are also discussed. Finally, the possibility of international medicine is also mentioned briefly. 2010-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/92753 標題: 高齡金融新藍海：以A公司為例; New Blue Ocean for Senior Finance: Taking Company A as an Example 作者: 朱漢鼎; Han-Ting Chu 摘要: 台灣預計在2025年將達到超高齡社會，在人口老化趨勢中，我們看到銀髮商機蓬勃發展，同時現有退休金制度不足，步入高齡後隱含的財務風險，對國家財政與個人生活品質都產生極大的考驗。 在現有的三層退休金制度下-社會保險、職業退休金、個人儲蓄準備，國人該如何妥善規劃個人的退休金方案，以及強化企業退休金支柱，透過有計畫地提前部署，確保人生下半場無虞的退休生活，本研究參考鄰近日本的退休金制度，提出符合台灣國情的高齡金融建議，希望帶給政府機關在政策制定上的靈活度。 從退休金的三層架構，第二層的職業退休金與第三層的個人儲蓄準備金方案是亟待開發的市場機會。在職業退休金，產學界一直盼望開放勞退自選平台，以及個人儲蓄準備給予稅賦優惠，在整個退休理財市場蓬勃發展下，投信投顧產業可以利用產品設計能力、投資專業能力、財商教育能力，搭配跨產業的生態鏈，發展退休市場新藍海，這也是個案公司在高齡金融商機的下一個成長引擎。 本研究由台灣人口結構變化、高齡就業、退休金制度作大環境分析，並收錄日本的退休制度方案作為參考；在個案分析中，從PESTEL梳理大環境的機會與威脅，由SWOT分析看個案公司的策略選項，如何在高齡金融市場掌握先機，以5C架構與STPS的策略軸線發展，論述個案採取的戰略與戰術執行，再從TAM/SAM/SOM評估目標市場規模，以及系統化商業模式，為潛力市場的自選平台與個人儲蓄提出論述方向。; Taiwan is expected to reach an ultra-aged society by 2025. In the trend of population aging, we see thriving opportunities in the silver economy. Meanwhile, the existing pension system is inadequate, and the implicit financial risks that come with advancing age pose significant challenges to both national finances and individuals' quality of life. Under the existing three-pillar pension system - social insurance, occupational pensions, and personal savings- how should individuals properly plan suitable retirement schemes and strengthen the corporate pension pillar? By deploying plans systematically in advance, we can ensure a worry-free retirement life in the second half of life. We propose elderly financial suggestions tailored to Taiwan's situation, drawing from neighboring Japan's pension system. Within the three- pillar structure of pensions, there are urgent market opportunities in the second pillar of occupational pensions and the third pillar of personal savings. In the realm of occupational pensions, the academia and industry have long hoped for the opening of voluntary retirement platforms and tax incentives for personal savings. Amid the flourishing retirement financial market, the mutual fund and investment advisory industries can leverage their product design capabilities, investment expertise, and financial education capabilities, along with cross-industry ecosystems, to develop new blue oceans in the retirement market. This study analyzes the macro-environment of Taiwan's demographic changes, elderly employment, and pension systems, and includes Japan's retirement system proposals for reference. In case studies, opportunities and threats are outlined through PESTEL analysis of the macro-environment, and strategic options for case companies are examined through SWOT analysis. The study discusses strategies and tactics adopted by the cases to seize opportunities in the elderly financial market, develop strategies and tactics through the 5C framework and STPS strategy axis, evaluate target market sizes through TAM/SAM/SOM, and propose systematic business models for potential markets. 2024-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78832 標題: 高齡化社會趨勢下區域醫院之定位策略_臺北市立聯合醫院個案研究; The positioning strategy of metropolitan hospitals under the trend of aging society: A case study of Taipei City Hospital 作者: Shang-Yih Chan; 詹尚易 摘要: 台灣的醫療在健保制度下長期為國外學者及機構評等為高品質及低成本而獲得許多讚許，國內民眾對於健保的滿意度在政府施政評比中亦常名列前茅，然而重治療輕預防的醫療體系、醫療勞動環境惡化、醫療機構重績效輕價值、重服務量輕品質的經營模式近年常為人詬病，健保採用總額制度雖然成功的抑制了醫療花費的增長，同工不同酬的制度造成了醫療機構過去幾年呈現M型化的發展，中型醫院競爭力不足，民眾就醫紛紛湧向醫學中心，造成急診室壅塞及急重症資源耗費，未落實分級醫療制度亦增加了醫療資源的浪費。 老年化社會的來臨，台灣迫切的危機更甚於其他先進國家，除了面臨醫療需求量的增加、需求內容亦有所改變，醫療產業面對銀髮海嘯的衝擊，老人安養照顧的需求、減少失能以及安寧善終等議題該如何應對，此外醫療科技的大幅進步帶來醫療創新的可能，也提供了解決問題的可能性。 針對外部環境的重大改變以及醫療技術的進步，中型醫院面臨的是危機也是轉機，醫院該採取何種應對策略以及內部組織該如何調整，都值得深入研究。本研究希望藉由醫療產業分析以及老年化社會對於醫療產業的衝擊為切入點，先藉由文獻探討以策略定位、五力分析以及破壞式創新的理論，再輔以台北市立聯合醫院為個案研究對象，探討區域醫院於醫療產業可以採取之定位策略，希冀在此定位下區域醫院可以提出有益於整體醫療產業未來發展的策略及計畫。; National health insurance (NHI) system in Taiwan has long been highly prasied by many famous scholars and institutions for its high quality and low cost. However, the hierarchy of medical services has not yet been well implemented and many patients have chosen to flock to medical centers. This leads to the waste of medical resource and many medium-sized hospitals failed to compete with medical centers and clinics in Taiwan. With the advent of an aging society, the medical system in Taiwan is also facing the impact of the silver tsunami, including the need for elderly health and life care, end of life care and the hospice. In response to these environmental changes, medium-sized hospitals in Taiwan are facing the crisis and turning point. Therefore, it is critical for medium-sized hospitals to explore new positioning strategies for the challenges. We use the Taipei City Hospital as a case to explore the possible positioning strategies that metropolitan hospitals can adopt in the future. Results, implications and limitations for future research are then discussed. 2019-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78799 標題: 高階醫學影像健康檢查全平台商業模式探討 —以臺安醫院高階醫學影像中心為例; A Business Model of Advanced Medical Imaging Health Examination Whole Platform — A Case Study of Taiwan Adventist Hospital Medical Imaging Center 作者: 許慧貞; Hui-Chen Hsu 摘要: 隨著國人經濟條件改善與健康意識的推廣，21世紀的醫療型態已經從「疾病-治療模式」轉變為「疾病-預防模式」，“健康促進”與“健康檢查”也成為「疾病-預防模式」的兩大基石。第二級基石的“健康檢查”是於每年選一天進行健康檢查，以達到早期診斷早期治療的目的，而高階健康檢查是一種新的健康檢查方式，它應用影像醫學中較先進與安全的技術大量採樣與取像，在短短一到二個小時內利用安全的工具收集個人數千張的各種切面的清楚影像以供醫師診斷，在眼見為憑的清況下才能有值得信賴的影像診斷，可以解決許多不必要的疑慮，所以深受部分國人的信賴。 既然預防醫學與高階醫學影像健檢之需求蒸蒸日上，為長遠永續經營角度出發，我所任職策略長的醫影公司便不該只守住當初設立的經營思維，僅為醫療院所設備租賃管理合作與健保服務，還應順應目前產業發展，找出可運作的共用經濟模式，解決目前健檢市場上中小健檢中心無法添購大設備的問題，並提升民眾對癌症及影像醫學精準檢查的認同，整合高階醫學影像商業模式與醫療共用經濟模式。 本論文所探討議題包括：如何以「臺安醫院高階醫學影像中心」這個創新的商業模式幫我任職策略長的「醫影公司」找到可以增加企業價值的商業模式，並延續競爭優勢與持續造就創新。「付得起，信得過，離得近，排得到」是「臺安醫院高階醫學影像中心」的經營理念，而「醫影公司」可憑藉發展出「高階醫學影像健康檢查全平台(Wholescale + Total solution)商業模式」的商業模式理論與實務經驗，讓新技術搭上商業模式的改變而成為真正的創新。 結合商業模式創新的相關理論，本研究以商業模式畫布、價值鏈與價值網、SWOT環境分析，TOWS戰略分析以及藍海策略，為本研究塑造更嚴謹的學術理論架構。 本論文研究範圍，以高階健檢產業為研究系絡，尤其聚焦於附屬於醫院之內的高階醫學影像中心，探討如何突破現有產業的發展困境，與眾多獨立經營的健檢機構合作擴大市場，並運用適當策略學理，建立創新的高階醫學影像健康檢查全平台商業模式，以做為有心從事健康檢查業者未來經營之參考。; With the improvement of economic conditions and the promotion of health awareness, the medical model in the 21st century has changed from "disease-treatment mode" to "disease-prevention mode", and "health promotion" and "health check" have become the two cornerstones of "disease-prevention" mode. The “health check” of the second-level cornerstone is to conduct a health check every year for early diagnosis and early treatment. Advanced medical imaging health examination is a new health check method, which uses advanced and safe technology in imaging medicine. In a short one to two hours, it uses safe tools to collect thousands of clear images of various aspects of the human body for the diagnosis by the radiology physician. In the clear conditions of “we believe what we see”, reliable imaging diagnosis could be gotten and many unnecessary doubts could be solved, so this health check method is deeply trusted by some people. Since the demand for preventive medicine and advanced medical imaging health examination is booming, for the long-term sustainable business development, the medical imaging company I am working for as a chief strategy officer should not only hold the business model originally established as the equipment provider by rental management and cooperation with medical institutions. We should also conform to the current industrial development, find out the operational sharing economic model, solve the problem that the small and medium-sized health check centers cannot purchase large equipment in the current health check market, and enhance the public's awareness of the importance of accurate early diagnosis of cancer, and integrate the advanced medical imaging health examination model and medical sharing economic model. The topics discussed in this paper included: how to use the innovative business model of "Taiwan Adventist Hospital Advanced Medical Imaging Center" to help us find a business model that can increase the value of the "Medical imaging Company" and continue the competitive advantage and continue to create innovation. "Affordable, Trustworthy, Close, and Obtained" is the business philosophy of "Taiwan Adventist Hospital Advanced Medical Imaging Center", and "Medical imaging Company" can develop "advanced medical image health examination whole platform (wholescale + Total solution) business model” by combination of business theory and practical experience, then let the new technology take the change of business model and become a real innovation. Combining the relevant theories of business model innovation, this study uses business model canvas, value chain and value network, SWOT environment analysis, TOWS strategy analysis and blue ocean strategy to shape a more rigorous academic theoretical framework for this research. The scope of this thesis is to study the high-level health check industry, especially focusing on advanced medical imaging centers affiliated with hospitals, to explore how to break through the development dilemma of existing industries, and to expand markets with many independently operated health check agencies. We also use appropriate strategy theory to establish an innovative advanced medical image health examination whole platform business model, as a reference for the future business of health check companies. 2019-01-01T00:00:00Z