創造骨科醫療照護服務價值：專科整合性醫療健康照護的營運模式

Create Value of Orthopedic Healthcare: Business Model of Integrated Orthopedic Specialist Healthcare Service

林繼昌(Chi-Chang Lin)

指導教授 ： 江炯聰

國立臺灣大學/管理學院/高階公共管理組/碩士(2008年)

https://doi.org/10.6342/NTU.2008.00274

摘要

過去幾十年來，醫學知識爆炸與科技的突飛猛進，導致專科分科化的必要性與現實性，專科醫療照護雖然素質整齊專門而精深，其最大的盲點則為分散片段不連續，忽略了基本「全人照護」的精神。當今全民健保給付緊縮的趨勢下，許多新的治療項目無法得到給付，產生病人自費醫療模式，反而造就一系列的單專科醫療照護服務行業。社會殷切需要的是整合性全人醫療照護，專科醫師人數與素質均處於有利的地位，有必要發展出另類的照護服務營運模式─專科全人整合式醫療健康照護服務模式並以骨科醫療提升病人價值出發。
以健保給付制度之失焦，重新界定人們對健康照護服務產業的認識，對從事醫療工作人員的態度思考，從醫療志業轉移成醫療產業，對醫療處置的多樣性及滿意度，從必要性醫療到消費性醫療，提高醫療服務的水平，從醫療秘偏方到標準配方，與從投資的角度觀點，從人力市場改變到資本市場，這些觀念思考的改變，決定接續的以病人價值為動力的整合性醫療健康照護服務產業的成敗。
除了骨科傳統醫療技術平台，疾病前的健康的提升，治療後身體功能的復健，都牽動無數的骨科照護服務產業價值鏈─如運動、健康飲食、保養及復健醫療等相關產業，了解整個價值鏈，便可找出藍海利基，彌補健保給付受限的窘境，開創新局。實際營運模式包括成立骨科醫療服務鏈仲介管理中心、建立骨科網路資訊平台，配合Web 2.0網路醫療架構和實體的問題諮詢事務中心，價值鏈的垂直整合，除了造成鎖住客戶效果外，也可提高進入障礙。實際營運模式包括Web 2.0網路醫療架構和實體的問題諮詢事務中心，關鍵的競爭力在於對於客戶疾病體能做仔細和連續性的評估，須借重完善的資訊科技(IT)技術及軟體建設。也可提高進入障礙。實際業務執行以骨科單門疾病防治管理中心為骨幹，消費者能一目了然，由於整個醫療服務價值鏈的完整，可增加消費者的信心。
整合性專科健康照護從概念到實際，仍需多方面配合，但無疑是將來必走的道路。有了整合性專科健康照護經驗，可以在各專科間再創造新的連結，未來的發展端視網路整合的程度而定，也可預見是價值導向醫療的實現。

關鍵字

骨科專業 ； 復健醫院 ； 整合醫療 ； 營運模式 ； 價值鏈 ； 垂直整合 ； 消費性健康照護市場

並列摘要

In the past decades, as the explosion of medical knowledge and progress of biotechnology science, the well-trained medical specialists are widely welcome and popularized, but the segmentation and discontinuity of specialist healthcare also demonstrate their weakness in treating the patient as a whole person rather than a specific organ system. Nowadays for the shortage of payoff system, many new or advanced healthcare items innovated especially by most medical specialists are denied by the insurance payer that patients should pay by themselves if they stick on the treatment. This promotes the development of specialist practice in public for maintenance of their economic level. With the balance of benefit of the general and specialist practice, integrated specialists service targeting the value of the patients might become a future mode of healthcare for their adequate population and excellent quality. This will be started with the integrated orthopaedic specialist practice.
Before the implementation of integrated specialist practice, some concepts of healthcare service should be updated. The traditional medical mission for healthcare personels may be shift to value-added healthcare service industry. The idea of consumption health service has to be built up in addition to prerequisite medical service. The mystery of medical treatment should be released in a transparent, systemic format for health personels to follow. In order to achieve economic volume, the manpower type of market is to be replaced by the capital market through standard procedure in diagnosis and treatment with the aid of advanced modern informative technology.
In addition to the core business of healthcare service for the patients who come to seek help from orthopedist specialists, there are many concerns before and after the management in the orthopedic healthcare value chain system. The business model of integrated orthopedic specialist practice service is to link all the possible niche market to create the value of the patients based on their points of view. In order for the avoidance of further bone trauma or disease, one should promote his status of health through delivery of medical knowledge, diet and healthfood prescription and participating in physical exercise and sport activity. In the post-orthopedic management healthcare, physical and occupational therapy is the golden link in this value chain to restore the functional loss. There are a lot of paramedical industry in supplying the materials, instruments and facilities in the orthopaedic service value chain.
For the compensation of inadequate pay from the insurance, it is an opportunity to build up a new integrated healthcare system aiming for creation of patient value. By way of vertical integration of the healthcare value chain including sports, diet and health food for the health status and physical therapy after management, it will make a lock-in effect for the customers and the entry barrier for the competitors. The implementation of this integrated healthcare model comes from a setup of an agency service for the customers with orthopedic complaints and problems and an internet healthcare information system with web 2.0 format in data acquisition and a medical problem consulting service station in real world. The practice will start with one single disease or function disorder such as osteoporosis or inadequate height for the public. Its key success factor lies on the complete and consequent serial evaluation of patient’s body and function by way of intimate IT and software system.
The fulfillment of integrated practice idea of medical specialists is not a step but a long way to go with interdisciplinary connection and cooperation. The ideal clinical practice network is achieved by re-integration of each integrated subunits of specialists practice in each special field. Its success will depend on the interconnectivity of the patient information and medical technical knowledge in the net for the prospect of value driven healthcare.

並列關鍵字

Othopedic specialist practice ； rehabilitation hospital ； integrated healthcare ； business model ； value chain ； vertical integration ； consumer healthcare market

參考文獻

13. 陳瑞榮：台灣醫療產業的組織合作─不對等合作估系運作機制之探討. 台灣社會

14. 盧瑞芬、謝啟瑞：台灣醫院產業的市場結構與發展趨勢分析, 經濟論文叢刊

17. 江東亮：台灣醫療保健支出之趨勢分析. 台灣衛誌 21(3):157-163. 2002

20. 張鴻仁、信忠：全民健保醫療利用集中狀態及高低使用者特性之探討. 台灣衛誌

25. 李丞華：從效率面談台灣健康體系的再造. 台灣公共衛生雜誌 22(2):89-96. 2003