台灣醫療產業發展之分析

Abstract

台灣醫療產業環境因人口結構轉型為老齡化社會、國人對醫療服務意識提高，同時要求醫療品質，對各醫療院之自費項目需求增加；加上社會經濟結構改變，疾病型態轉變已由急性、傳染性疾病，轉變成以惡性腫瘤、心血管等慢性疾病等為主。此外，醫療產業面臨全民健保及近年之健康照護升值白金方案之影響，使得醫療院所面臨結構性調整，且醫療機構因應醫療意識抬頭，預防保健觀念興起使得護理機構呈現逐年成長趨勢。 本研究為文獻回顧，首先整理近年來台灣醫院產業發展之相關研究，接著討論台灣醫療產業環境變遷、醫療產業現況及發展趨勢，包括結構性改變、醫療機構型態改變等現象，及醫院如何發展以增加競爭力。接著針對極具代表性之公立醫院及私立醫院進行個案分析，最後歸納出結論如下： 醫療產業雖受醫療相關法規嚴密監管，屬於管制性極高之產業，但其產業發展脈絡與其他產業之策略走向無異，皆須往規模經濟與範疇經濟發展以增加其競爭力。規模經濟主要採合併、委託經營、聯盟與擴建等四種方式；範疇經濟係多角化發展各種自費醫療服務項目，以達營收成長、控管成本等改善財務結構之效。 具體建議為：公立醫院仍可在政府體制下積極發展多角化服務項目，在營運效率與公共利益取得平衡，以維持其公立醫院之角色。私立醫院在擴大規模或發展多角化時，須謹慎評估以免產量超過最適量造成規模不經濟，亦或投資未具相對優勢之服務項目，因組織內資源無法有效運用造成範疇不經濟之後果。

In past decade, the demand on self-paid medical care services and high quality of healthcare in Taiwan is increasing. It results from the change of population structure to ageing society and urged awareness on medical care quality. Then, the social wealth accumulation changes the lifestyle and dietary habit in Taiwan. Thus, the medical cares focus on accident & emergency and infectious diseases in past shifting to chronic diseases such as malignant tumor and cardiovascular disease. Furthermore, the medical care industry confronts structural adjustments due to National Healthcare Insurance and value added healthcare package. The nursing institutions also benefit from the growth of preventive health awareness in Taiwan. The research focuses on literature review. First, review the relevant papers on recent development of Taiwan hospitals. Then, discuss the transformation, status quo and development of Taiwan medical care industry, including structural reform, changes of medical institutions and the improvement on capacity of hospitals. Furthermore, follow the solid case studies on representative public and private hospitals. Thus, conclude few observations as below. Although the medical care industry is supervised by strict healthcare disciplines and regulations, formed as highly command industry, its development and strategy are in consistent with other industries, i.e. increase competiveness by developing economies of scale and economies of scope. In terms of economies of scale, four common strategies are merge, delegated management, alliance and expansion. Regarding economies of scoop, develop diverse business on self-paid medical care item to fulfill the sales growth and cost down. The work suggests that public hospitals by government supervision can approach the balance between the operation efficiency and public benefit in extending diverse medical care services under government supervision. On the other hand, private hospitals need to carefully access the expansion or diverse services in prevention of diseconomies of scales and diseconomies of scoop. The former is caused by the oversupply and the latter might be generated by organizational inefficiency of inappropriate investment on less competitiveness business.