- 學位論文
醫療檢驗用品供應鏈長鞭效應之
A Study of the Present Situation of the Bullwhip Effect in Clinical Diagnostic Lab Supply Chain and Strategy Development of Supply Chain Process Improvement
摘要
摘要 全民健保實施至今，醫療院所的主要醫療收入成長趨於緩和，因此在開源不易的情形下，各醫院皆朝向節省成本的方向努力。然而，隨著醫院的經營壓力逐漸增加，降低成本的壓力也從醫院端擴散到上游的供應廠商，使廠商面臨極大的經營壓力，亟需降低產品在流通過程中之浪費，以及改善整體服務績效的機會，因而突顯了從整個醫療供應通路上、中、下游進行整合，共同降低通路成本以改善經營困境的重要性。 研究的目的分成二大部份，第一部份是要確認醫療檢驗用品供應鏈「長鞭效應」的存在與了解需求擴大的特徵，並試圖分析「長鞭效應」的成因；第二部份期以供應鏈的角度發展醫療檢驗用品供應鏈整合之策略方案以解決產業面臨的問題。 研究結果發現如下： 1.醫療檢驗用品通路供應鏈長鞭效應分析與需求擴大特徵 (1) 針對個案醫院的檢驗用品供應流程進行評析的結果發現，未來若要整合醫療檢驗用品通路時，應優先選擇物料管理機制較完善的機構進行整合，其整合效益與可行性較高。 (2) 研究發現檢驗用品需求擴大的特徾為－透過有效的物料管理將可降低檢驗作業需求的不確定性，顯示物料管理機制的良窳影響檢驗用品供應鏈長鞭效應的程度相當深遠。 (3) 根據個案研究與文獻探討發現，可能造成醫療檢驗用品供應鏈長鞭效應的關鍵因素包括前置時間、庫存調整速度、資訊傳遞速度、訂購批量、需求預測、需求不確定及供應品質的穩定度。 2.醫療檢驗用品通路不同階層現況之問題與機會 (1)下游醫院端的作業效能與管理良窳，攸關檢驗用品供應鏈的效率甚多，再加上需求最終會驅動產品訂購與補充程序，因此醫療院所應該特別著重供應的需求管理。從個案研究發現，各家醫院之醫療檢驗作業程序相當不一致，因此醫療用品供應鏈的整合應先從醫院端的整合著手。 (2)目前檢驗用試劑及耗材的供應作業方式，為各家原廠將自己的產品給不同的經銷商來代理，各家經銷商自行負責銷售與物流業務，並視代理內容而做不同程度之售後服務。由現況評析，醫檢用品通路具有很高的整合機會與效益。 (3)目前醫療檢驗用品通路乃由幾家較大規模又較專攻單一科別的經銷商所組成，並與原廠-多為美、歐、日系之外國大型跨國企業，保持良好的經銷合作關係。因此供應鏈之整合，應由具規模及互補性的原廠與經銷商共同擔任發起及整合的角色，成功機率會較大。 3.整合策略發展 經過系列研究過程，研擬以下之醫療檢驗用品通路整合策略方案： (1). [醫院端整合]：醫療檢驗用品管理機制的改善 (2).[經銷商虛擬整合]：經銷商物流整合，降低配送成本、提升服務 水準。 (3).[供應鏈整合]：醫院與經銷商共同規劃檢驗耗材需求。 關鍵字：醫療檢驗用品通路、供應鏈整合、長鞭效應、醫療檢驗用品供應商、醫療檢驗作業
並列摘要
Abstract Since the implementation of National Health Insurance (NHI), the chief medical income growth in medical care institutes has become stable. Since it is hard to gain more earnings, hospitals are putting efforts into saving costs. However, as running a hospital is becoming intensively pressurizing, the burden to lower costs has spread from hospitals to purveying manufacturers. These suppliers, who are facing great pressure in operation, are in need of lowering the waste of products during distribution and improving the service performance integrally. Therefore, the significance of lowering distributional costs and improving the operating difficulties by integrating the up-, mid- and down- streams of the medical care supply channels is highlighted. The objectives of this study are divided into two parts. First, certify the existence of the bullwhip effect in the clinical diagnostic lab supply chain, understand the characteristic of demand amplification, and try to analyze the causes of the bullwhip effect. Second, develop a strategy for the clinical diagnostic lab supply chain from the aspect of a typical supply chain, in order to solve the problems faced in the industry. The study results are as follows: 1. Analysis of the Bullwhip Effect in the Clinical Diagnostic Lab Supply Chain and Characteristics of Demand Amplification (1) According to the evaluation results of the supply process of diagnostic lab equipment in several hospitals, it is found that if there is a plan to integrate clinical diagnostic channels in the future, the institutes that have well-functioning mechanisms for material management should be integrated in preference for higher efficiency and feasibility results. (2) The characteristic of demand amplification for diagnostic equipment is its ability to reduce the uncertainty of demands for diagnostic operation by efficient material management. This shows that the mechanism of materials management has a great impact on the bullwhip effect in the clinical diagnostic lab supply chain. (3) According to case study researches and reviews of related documents, it is found that the key factors which may cause the bullwhip effect in clinical diagnostic lab supply are lead time, shelving speed, transmission speed, batching of orders, demand forecasts, demand uncertainty, and supply quality stability. 2. Current Problems and Opportunities in Clinical Diagnostic Lab Supply Chain for Different Levels (1) The operation efficiency and management of down-stream hospitals have a great impact on the diagnostic lab supply chain. Demands will ultimately motivate the procedures for product orders and complements. Thus, medical care institutes should emphasize the demand management of supplies. From case studies, it is found that the procedures of clinical diagnostic operation in different hospitals are not consistent. Therefore, the integration of the clinical diagnostic lab supply chain should start from hospitals. (2) The method of current supply operation of tested reagents and consumable materials is: the products produced by different factories are franchised to different distributors that are responsible for distribution and logistics services separately and provide different customer services according to different types of franchises. After evaluating the status quo, it is found that the clinical diagnostic lab channels have good opportunities and efficiency in integration. (3) Currently, the clinical diagnostic lab channels consist of several large-scaled distributors that focus on one single department and keep good cooperation relationship with big international enterprises, primarily in the U.S., Europe, and Japan. Thus, the integration of the supply chain should be initiated and integrated by the factories and distributors that are large-scaled and have complementary features to ensure higher success rate. 3. Development of Integration Strategy After conducting a series of research, the integration strategies for clinical diagnostic lab supply chain are planned as follows: (1) [Hospital Integration]: Improvement of the management mechanism for the clinical diagnostic lab. (2) [Virtual Integration of Distributors]: Logistics integration of distributors, distribution cost lowering, and service level upgrading. (3) [Supply Chain Integration]: Effective collaboration of lab-consuming materials by hospitals and distributors. Key words: Clinical diagnostic lab channels, Supply chain integration, Bullwhip effect, Clinical diagnostic lab suppliers, and Clinical lab examination process