全民健保給付規定對醫療器材產業經營策略與市場形塑計畫之影響 - 以A醫療公司之A產品為例

Abstract

Abstract In Taiwan, everyone has health insurance and the coverage rate of national health insurance has already exceeded 99%; the health care benefits are also broadly covered and reimbursed, almost all-encompassing. As a result of the high insurance rate and high disease coverage rate, the National Health Insurance Administration (NHIA), Ministry of Health and Welfare has become the largest payer for the health care industry in Taiwan. Therefore, the reform of the national health insurance policy has significant impact on the operation and development of the entire health care industry. The financial status of national health insurance has always been a key focus of the public. Since being founded in 1995, with the ultimate goal of achieving a balance of payments, National Health Insurance Administration (NHIA) carried out a number of policy changes, such as global budget payment system, comprehensive drug price surveys, hospital self-management, Fee-for-service, and second-generation national health insurance, which was implemented in 2013. These changes in reimbursement policies are mainly to reduce or control expenditures, in order to achieve the goal of sustainable health care for all. The national health insurance policy, which control expenditures, hinders market growth, operation and development of the health care industry and even patient safety. The case study uses literature and company confidential data analysis to explore the impact of changes under national health insurance policy on Taiwan's health care industry. It also uses “Case Study Method” to explore the impact of the case company under a critical environment and how it faces challenges and comes out with an effective strategy. The case study concluded that changes with national health insurance policy caused the case company product to vanish from the health care market and affected company operational performance. The case company leveraged health care professionals to re-enter the market successfully and resulting of the product being fully reimbursed by NHI instead of being a self-pay product before 2012. The transformation of this business model has allowed the case company product to continue growing, getting rid of the competition and shaping the market.