健康檢查服務的商業化

Abstract

隨著生物醫學科技的進步，人們對健康照護的期望和要求也日益上升，導致健康照護費用支出不斷增加。因此，世界各國紛紛引進市場機制於健康照護體系中，期望藉此控制健康照護費用的支出。臺灣的全民健康保險制度也面臨到同樣的挑戰，加上醫療機構之間的競爭日漸激烈，全民健保於是開始實施費用控制的相關政策。大部分的醫療機構在此經營環境下，紛紛拓展自費的健康照護服務，其中，健康檢查服務便是一個顯著的例子。 本研究以健康檢查服務為例，檢視健康檢查如何由原先的政府提供的非營利服務轉向商業化發展。研究對象以目前市場佔有率較高的三家民間健檢診所及大臺北地區九家醫學中心的健檢部門為主；在研究設計的部份，使用「三角交叉測定」來收集多元的研究資料，包含：文獻、報導、健檢機構印製的文宣品、圖片和與健檢部門管理者的深度訪談等資料，以探索這項特殊的預防性健康照護服務在臺灣過去五十年的發展過程。 研究結果發現，臺大醫院自1956年開始提供自費健康檢查服務，這項服務便被「商品化」了，其後，當時的幾家大型醫院也陸續提供類似的服務。然而，在1990年代崛起的民間專業健檢診所，才是將預防性健康檢查服務推向「商業化」的關鍵。本研究以商業化的定義為主軸、提出相關的資料，闡述健康檢查服務如何導向商業化，並探討醫療機構採用何種經營行銷及市場區隔策略來推展自費健檢市場，使其成為健康照護體系中最能帶來利潤的自費服務項目。 最後本研究提出，健康檢查的商業化現象可能會對健康照護體系帶來一些影響和衝擊。值得注意的是，醫療機構可能會以多樣的「吸脂定價」策略提供自費服務項目，進而對政府提供的健檢服務帶來潛在的「排擠效應」，並可能忽略對醫療本業的投入。此外，醫療機構以自費健檢為發展利基，購買昂貴的高科技精密儀器，也會加深醫療機構之間的「醫武競賽」。本研究試圖指出，當醫療服務成為商品且逐漸商品化時，將漸漸改變我們對健康照護服務本質上應為「公共財」的認知，健康照護服務不只會成為「商品」，也成為投資者用來牟利的工具。健康照護商業化發展的結果，將使得個人的付費能力決定其所能獲得的健康照護服務水準，如此一來，儘管在全民健保的制度下，族群之間的健康差異亦將會擴大。

With the advance of biotechnology, the public’s expectation for higher level of health status and the needs for health care increase rapidly, and as a result, which escalates health care expenditure. In face of this crisis, many countries introduce market mechanism into the health care system and hope to control the health care cost. Without exception, Taiwan’s National Health Insurance (NHI) system also faces the similar challenge and the increased competition between health care organizations. Rigorous cost containment becomes unavoidable. Under NHI’s cost control policy, most health care organizations have started to open up a wide array of private health care services, and among them, “health screening service” (HSS) is particularly an embraced part. This research aims to take HSS as an example to examine how an originally government supported, non-for-profit health care service becomes commercialized. Three private health screening clinics and the health screening center of nine teaching hospitals in Taipei Metropolitan area are main study samples. Based on a triangulation design, a variety of data, from different types and sources of documents, reports, printed materials, photography to in-depth interviewing with directors of each centers, were collected to explore the process and development of this specific area of “preventive health service” in the past five decades. The major findings of the study indicate that health screening was not “commodified” until 1956 when the first self-paid service was provided by National Taiwan University Hospital, which had stimulated similar kind of service items made available by other hospitals. Perhaps the most important was the birth of private clinics specialized in health screening and examination observed in the early 1990s, which have pushed the preventive examination services into the direction of commercialization. This study discusses the definition of commercialization and provides data to support and evidence with regard to how commercialization has initiated, and in what way and to what extent it is continued and facilitated, becoming one of the most prosperous, profitable item of services to the hospitals. The marketing strategies adopted by these hospitals and the way they keep market share are addressed. The study also presented and elucidated possible adverse impacts that this ongoing commercialization process might exert on the health care system. Particularly worth noting include various cream-skimming practices of physicians and hospitals such as crowding out the health examination services provided by government, and overlooking or unwilling to engage in disease treatment. In addition, aggressive “medical arms race” between health care organizations has been on the way. The study warns that, when health care become a commodity and rapidly commercialized, it is likely that the fundamental value of health care as a public good will erode gradually. Capability-to- pay will decide whether and what services one could possibly has, and in that case, health inequality might be extended despite the existence the NHI. Policy suggestions are proposed in response to the jeopardy from commercialized health care like health screening services.