台灣醫療服務業之競爭策略分析

Abstract

醫療保障是世界上所有政府都極為重視的民生議題，每一個國家的醫療政策都不盡相同。從醫療服務產業觀之，台灣社會雖然是以資本主義發展為主軸，然過去醫療法規卻對大型醫院組織型態要求醫院須符合絕對公益化之色彩。一直到2004年醫療法修正通過後，才允許有醫療社團法人之營利型組織型態出現。新醫療法對醫療社團法人的社員資格限制，亦將公司組織排除在社員資格之外，亦即否定營利的公司組織參與投資醫院。關於這點，反而和號稱實施共產主義的中國大陸正好相反。同時，台灣法律亦規定全台灣民眾都必須依法參加全民健保，由中央健康保險局統籌辦理，類似實施社會主義制度。 本研究擬從競爭策略分析的角度，探討台灣醫療服務產業經營所需面對之不同經營環境與採取不同之策略，並嘗試建立策略分析架構，以預測未來產業可能之變化與採取之因應策略。主要使用的研究方法為文獻回顧法、深度訪談法與歸納法，以獲取本研究所需之資料。再運用SWOT分析以及圖表法，以探討實施全民健保後，醫療院所之發展趨勢及競爭能力之優劣。 經本研究所得資料分析結果，結論如下： 一、台灣醫院產業面臨幾乎是單一買家的中央健保局，已經造成許多地區醫院因嚴重的虧損而退出市場。健保局採取各種論量計酬或論病計酬制度，甚至限制醫院的自由發展，雖然可降低醫病資訊不對稱與控制預算，然而此一制度卻扭曲原先希望建立分級轉診醫療產業經營環境之本意。 二、台灣民眾目前對健保制度滿意度很高，但健保制度是否可以提升就醫品質、維持醫療效率與是否有能力永續經營，則被普遍存疑。長期來說，健保制度恐怕仍將持續嚴重虧損，未來就醫資源與品質恐將下降。 三、台灣民眾比較喜好到大醫院看病，這可從醫院天天人滿為患和早些年大型教學醫院申報件數之市佔率看出。但自健保逐漸拉大自負額差距後，近兩年來，大型教學醫院市佔比率從10%降至8%。因此，民眾雖然希望擁有教學醫院的門診品質，卻不願增加對門診自負額的負擔。加上健保對於合理門診量的推動，可以預期民眾仍將提高至基層院所的就診率。 關鍵詞：醫療服務產業、競爭策略、外部環境分析

Healthcare is the most important issue in developed countries worldwide. However, every country adapts different strategies to satisfy its needs to maintain the health of the population. Prior to 2004, Taiwanese medical laws required all the major hospitals to be non-for-profit organizations. And the laws had been revised in 2004. The new medical laws allow different kinds of organizations to participate in healthcare service industry. However, it still excludes any commercial company as the sole owner of any hospital. This means that the capital of private or public company in Taiwan can not invest in hospitals. Meanwhile, medical laws require all the Taiwan people to join in the National Health Insurance Plan. As a summary, Taiwan medical system looks very similar to socialism countries. Taiwan’s government has been acting vigorously in find out the way to finance its National Health Insurance Plan and to adjust new system to keep plan continued. On the other hand, because the system is changed frequently, hospital operators can only face the new industrial structure changes. They have been trying their best to adopt different strategies. This thesis is intent to analyze the different competitive strategies adapted by Taiwanese hospitals. I want to explain how hospitals manage their outside environments and to predict future possible change of healthcare service industry in Taiwan. According to our research findings, we can conclude the followings: First, hospital industry in Taiwan is facing one single buyer, the National Health Insurance Bureau (NHIB) which causes very serious financial loss for some Area Hospitals. To keep these hospitals from closing, the National Health Insurance Bureau adopts different policies from the “Payment by Patient Numbers” or the “Payment by Diseases” to other quality performance index and allow hospitals to have more choices for their survive strategies. The limitation of free competition for healthcare industry in Taiwan, although reduce information asymmetry between physicians and patients, is helpless to improve the whole investment environment of the healthcare industry. Furthermore, proper referral system in healthcare still can not be created. Second, most people in Taiwan are satisfied with the current healthcare system, but also strongly question that whether the national health care system can improve the efficiency for them in seeking medical advice. People also question if the National Health Insurance Plan can run continuously. In the long run, Taiwanese believe that serious loss will eventually cause medical service quality drop in the future. Third, large hospitals are losing their outpatient market share from 10% to 8% because NHIB changed its payment structure. Patients like to enjoy high quality service but do not like to pay more for service in large hospitals. Mostly likely in the future, patients will use more outpatient clinics near their communities.