台灣基層診所的困境與展望：個案研究

Abstract

台灣的醫療資源豐富多元，醫療教育精進紮實，吸引了許多頂尖精英學子投身於醫療服務領域。自全民健保實施以來，民眾就醫習慣的改變，影響了醫療體系的醫療原則、服務方針，更在多如牛毛的遊戲規則中，找出了一條最大化申請健保給付款的存活之道。台灣健保總額因之逐年遞增，形成了無可修補的健保財務破口，乃至全民健保瀕臨破產困境。國民健康署因之愈益壓縮了各級醫療院所的給付條件；形成了健保財務與醫療院所經營的惡性循環。台灣醫療院所經營環境每況愈下，而其間受影響最烈的一群，可謂是基層診所了。本論文旨在探討台灣基層診所（以耳鼻喉科為例）面臨到那些影響穩定執業、永續經營的困境；進而分析基層診所的開業各項變因與成本利潤；更期望能在此中，引用醫療管理顧問公司的經營策略，融入基層診所的各項經營模式，以圖能找出基層診所永續經營的生機。

The medical resources in Taiwan are rich and diverse, and the medical education has been solid which attracted many top elite students devoting themselves to the field of medical services. Since the implementation of National Health Insurance, people changed their medical habits which also affected the operational principles and service policies of medical system. The medical system need to find a way to maximize the payment from National Health Insurance system among the numerous rules and then survived. Taiwan's total payment of National Health Insurance increased year by year, becoming an irreparable financial deficit, and could even make the National Health Insurance system bankrupt. The Health Promotion Administration, Ministry of Health Welfare, hence further compressed the conditions to pay for the medical institutions, which became a vicious circle between the National Health Insurance fund and medical management. The medical managing environment for Taiwan's medical institutions is deteriorating. The most affected groups are primary clinics. The purposes of this thesis are: 1. to explore the difficulties in front of the primary clinics (the case for Otolaryngology) which affects the stable practice and sustainable development; 2. to analyze the conditions and cost/profit to manage a primary clinic; 3. to provide the revised business model for primary clinics from the experiences of a medical management consultant company, so as to find out the sustainable operation model for primary clinics.