全民健保政策對醫藥產業經營策略與模式的影響- 以A公司為例

Abstract

全民健保的納保率已超過99%，在台灣可以說人人都有健康保險；健保疾病給付的含蓋率也相當廣泛，幾乎是無所不包。由此高保險人納保率與高疾病給付涵蓋率的特性，對於台灣醫藥產業而言，中央健保局已經成為最大的付費者，因此全民健保政策的變革深深影響整個醫藥產業的經營與發展。 全民健保的財務狀況一直是社會輿論焦點之一，1995年3月開辦的全民健保，在1999年開始出現財務缺口，隔年2000年4月，健保局實施第一次全面性藥價調查，調降藥品健保給付價格，健保藥費成長率確實在當年度受到控制；但或許是負回饋因素的關係，整體台灣藥品市場成長率卻在2000年爬上高峰。為了達成收支平衡的目標，健保局開始進行多項的政策變革，例如：總額預算支付制度、全面性藥價調查與調降、醫院自主管理、論病計酬等等，一直到2012年要實施的二代健保。這些支付政策的變革主要在減少或控制支出，以期能達成全民健保可以永續經營的目標。 對醫藥產業而言，控制支出的健保政策，等於限縮了市場的成長，也限制了企業的經營與發展，例如：歷年的健保藥價調降若加上2009年第六次藥價調查，業界估計影響達200億的話，歷年藥價調降總計達494.79億，占2010年整體台灣藥品市場的39.3%，對產業衝擊可說相當巨大。 本研究利用文獻與次級資料分析，探討全民健保政策變革對台灣西藥產業的影響；並以個案分析法，探討個案公司在此環境下面臨的衝擊，以及如何面對挑戰提出因應策略。研究結論顯示，健保政策變革確實使個案公司產品金額的生命週期縮短，進而影響營運績效；個案公司利用藍海策略的概念，重建市場邊界，切入自費市場，利用價值創新的原理同時追求差異化與低成本，並持續聚焦核心能力市場。此經營模式的轉變，讓個案公司得以持續成長，擺脫健保市場競爭激烈且成長不易的困境。

The mission of Taiwan’s compulsory National Health Insurance (NHI) is to provide universal coverage. There is over 99% of the population was enrolled in the program currently. The NHI system offers a comprehensive and uniform benefits package to all those covered by the program which covers most forms of treatment. The Bureau of National Health Insurance (BNHI) has become the single-payer of pharmaceutical industry in Taiwan. The policies transforming of NHI has been impacting on the management and development of total pharmaceutical industry. The financial burden is major focus of society. NHI program was launched in March 1995. The first financial gap happened in 1999. The following year in April 2000, BNHI implemented the first universal drug prices adjustment. The drug reimbursement fee was under control at that time; however, it is the peak year of growth for overall pharmaceutical market that may resulting from negative feedback in 2000. In order to balance billing for expenditure, BNHI has been implementing lots of policies, such as global budget payment system, drug prices adjustment, hospital self-management payment system, DRG and etc. The second-generation reform will be launched in 2012. All the above is in order to support the program to be sustainable. Based on pharmaceutical industry point of view, the saving program of NHI is the reduction of the market. For example, the reduction of drug prices adjustment is NT$ 49.479 billion which is 39.3% of pharmaceutical market in 2010. The thesis is based on literature and secondary data analysis to analyze the impact of NHI policies on pharmaceutical industry in Taiwan. The case study is to understand the strategy of A company facing the environment challenge. The study result represents product life cycle in value is shortened by NHI policies and then impact on performance. Through concept of blue ocean strategy by reconstructing market boundaries penetrate the self-paid market. Value Innovation — the simultaneous pursuit of differentiation and low cost. Focus on core competence market. The business model transform sustain the continue growing and waive from reimbursement red oceans.