健保制度下新診療模式診所群進入基層醫療市場之競爭策略—以某疼痛專科診所為例

Abstract

人類對於醫療品質與新進醫療技術的期待與追求是永無止境的。當醫療發展出現了嶄新而良善的療法時，如何運用專業的管理學知識與技巧，將此新醫療科技不但以最有效率與最合理成本的方式穿透(penetrate)至一般民眾身旁，成為庶民生活中的一部分，並且能從中獲取最大利潤，以維持永續經營，應是臨床醫師責無旁貸的重任，同時也是一大挑戰。在健保制度框架下，若以疼痛診療為例，則新創之“利基式的專科診所群(Clustered Niche-based Special Clinics)”應是提供此類新診療方式的最佳服務通路。 然而，新設診所在目前各級醫療院所激烈競爭及健保緊箍式架構與規範下，必須思考如何以創新之經營模式進入市場，而能持續地保持其競爭優勢。本文以疼痛醫療為例，提出以下幾項競爭策略:1.由醫師本人(而非團隊)擔任診療的核心提供者；2. 採用低風險高獲利的非藥物介入性治療模式(non-pharmacological interventions)； 3. 患者以健保身分就診，附加中價位自費治療的訂價方式；4.運用即時提供介入治療的特性，增加病患平均就醫時間，提高醫療品質，同時減少因過量看診而損失之遞減式健保診療費；5.開立優質少量短期之健保藥物，配合非健康食品，需醫師處方之生物等同藥物(bio-identical medications)；6.運用資訊科技，架設介紹新診療模式之部落格，由醫師本人親自與閱者互動並即時更新內容。這些策略可有效地在一般基層診所與機構醫療中，明顯地區隔出診療之市場，並吸引中產階級以上之消費者；而經由第一家新設診所的實踐，進一步確認了這些策略的可行性與獲利性。 展望未來，診所群發展之核心競爭優勢將是先進而友善的疼痛診療專業知識技術。因此，在既有基層與機構醫療雙重競爭之下，有效率地專業資訊管理將會是發展診所群之關鍵成功因素，而核心策略則包含:1.掌握最新疼痛醫療進展與研究結果；2.運用網路科技，架設群組內部教育訓練平台；3.以先進疼痛專業醫療知識之整合與傳授，作為凝聚診所群之“雁行策略”；4. 將原醫師部落格轉型為互動式專業疼痛醫學網站，並採取會員制；5.藉由專業知識品牌認證的機制，管理診所群之醫療品質，以取代傳統連鎖診所的經營模式。 經由本研究中競爭策略的分析、設定與實踐，未來新創基層診所在進入基層醫療市場時，本研究將能提供實際可用的理論架構與經營模式，作為創業者或投資者的參考。

Throughout human civilization, there have been endless social expectations for advanced medical technology and better medical quality. For primary care clinicians, it has been their responsibility but also challenging getting these brave new medical therapies into their daily practice; and that requires professional managerial knowledge and technique to make this process efficient, cost-effective, and continuously profitable. Taking pain medicine for example, the “niche-based special clinics cluster (NBSCC)”model may be the best service channel to introduce these new therapies under the regulations of National Health Insurance (NHI) here in Taiwan. Under the landscape of vigorous competitions from various levels of medical entities and the rigid regulations from NHI, however, the newly-developed clinics have to build up innovative business models and competitive strategies in order to successfully enter the primary care market. Taking the pain medical care as the niche, we propose the following major competitive strategies :1. set the physician him- or herself as the core treatment provider (rather than the medical team)；2. utilize niche-based, low-risk, high-profit non-pharmacological pain interventions, such as high-resolution ultrasonography (HRUS), dry needle myofascial release, dextrose prolotherapy, intra-articular hyaluronate injections, and bio-identical pain medications；3. add-on pricing policy, including NHI-covered payment for clinic entry with self-paid fee for the above-mentioned medical interventions；4. enhance quality of medical care via one-stop “diagnosis-then-treat” mode, increasing average patient visit span, and in the same time reduce the potential loss from the NHI cascaded reimbursement；5. minimize the clinic size, both for optimal operational management and future clinic duplications；6. build up a blog-based pain medical information platform as one of the knowledge-accessing portals for the patients. These strategies can effectively and clearly separate out a distinct segment in the primary care markets, therefore further attract our targeted customers such as the middle-class and beyond. Through the successful setting and running of the first northeastern Taiwan pain clinic which put these strategies into practice, our proposed model was initially proved and verified. Heading for the future, the advanced development of the special pain clinic cluster should focus on its core competitive advantage, namely the innovative and friendly pain diagnoses as well as treatments. Rather than traditional chain-clinic management, our research adopts the “swan geese flying theory”, which include the following key components: 1. taking the professional medical knowledge of the participating physicians as the core content of management；2. the knowledge management team of the cluster dose not actually own or run the participant clinics；3. member-paid web delivery mechanism of integrated new medical educational information；4. certification programs to gate the care quality of the member physicians；5. The leader of the clinic cluster plays the role of chief knowledge officer (CKO), taking lead in directing the geese (participant clinics) flying to the goal of “green medicine”, and allocating business profits towards the knowledge management team. Overall, the analyses, design, and verifications of this research can provide helpful insights for future medical entrepreneurs or investors as they intend to step into primary care markets.