高齡化社會趨勢下區域醫院之定位策略_臺北市立聯合醫院個案研究

Abstract

台灣的醫療在健保制度下長期為國外學者及機構評等為高品質及低成本而獲得許多讚許，國內民眾對於健保的滿意度在政府施政評比中亦常名列前茅，然而重治療輕預防的醫療體系、醫療勞動環境惡化、醫療機構重績效輕價值、重服務量輕品質的經營模式近年常為人詬病，健保採用總額制度雖然成功的抑制了醫療花費的增長，同工不同酬的制度造成了醫療機構過去幾年呈現M型化的發展，中型醫院競爭力不足，民眾就醫紛紛湧向醫學中心，造成急診室壅塞及急重症資源耗費，未落實分級醫療制度亦增加了醫療資源的浪費。 老年化社會的來臨，台灣迫切的危機更甚於其他先進國家，除了面臨醫療需求量的增加、需求內容亦有所改變，醫療產業面對銀髮海嘯的衝擊，老人安養照顧的需求、減少失能以及安寧善終等議題該如何應對，此外醫療科技的大幅進步帶來醫療創新的可能，也提供了解決問題的可能性。 針對外部環境的重大改變以及醫療技術的進步，中型醫院面臨的是危機也是轉機，醫院該採取何種應對策略以及內部組織該如何調整，都值得深入研究。本研究希望藉由醫療產業分析以及老年化社會對於醫療產業的衝擊為切入點，先藉由文獻探討以策略定位、五力分析以及破壞式創新的理論，再輔以台北市立聯合醫院為個案研究對象，探討區域醫院於醫療產業可以採取之定位策略，希冀在此定位下區域醫院可以提出有益於整體醫療產業未來發展的策略及計畫。

National health insurance (NHI) system in Taiwan has long been highly prasied by many famous scholars and institutions for its high quality and low cost. However, the hierarchy of medical services has not yet been well implemented and many patients have chosen to flock to medical centers. This leads to the waste of medical resource and many medium-sized hospitals failed to compete with medical centers and clinics in Taiwan. With the advent of an aging society, the medical system in Taiwan is also facing the impact of the silver tsunami, including the need for elderly health and life care, end of life care and the hospice. In response to these environmental changes, medium-sized hospitals in Taiwan are facing the crisis and turning point. Therefore, it is critical for medium-sized hospitals to explore new positioning strategies for the challenges. We use the Taipei City Hospital as a case to explore the possible positioning strategies that metropolitan hospitals can adopt in the future. Results, implications and limitations for future research are then discussed.