台灣醫院產業的發展:以長庚醫院與台大醫院為例

近年來，經濟發展到一定程度的國家，其人口結構變化，都有一個共同性的趨勢，就是新生兒的出生率下降，這造成了部分國家人口增長的停滯現象(甚至是負值)。利用聯合國網站提供的服務，去統計全世界人口數每五年的變化，從這個統計的結果來比照我國人口變化的趨勢，可以發現有極大的參考價值。自二戰後，我國經濟實力逐步增強，自開發中國家向已開發國家邁進，姑且不論政治上的爭議，在人口成長率上的變化，幾乎完全符合世界各國在聯合國網站上的統計結果。我國的經濟在過去的幾十年間快速發展，國人的生活水準提高，連帶讓醫療環境也有了大幅進步。醫療環境與產業的進步，使得過往的許多難以處理或治癒的疾病有了解決方案，國民生活水準的提高亦降低了意外事故發生的機會，因此，目前國人就醫的主要原因，已逐漸轉變為癌症與其它慢性疾病為主，也由於經濟與醫療環境的改善，國人的平均餘命增加，造成人口結構的變化，社會結構正朝向老齡化發展。為因應這樣的趨勢變化，除了已經開辦的全民健保外，衛福部(當時為衛生署)在2009年通過推動「健康照護升值白金方案」，目的在健全我國之醫療照護體系，透過大量的投資，期望在推動後的四年內，讓醫療照護體系的產值增加3,464億元，並同時增加31萬人次就業機會，在活化國內產業環境的同時，也帶動就業市場，達到一石二鳥的結果。國內的醫院產業，也因上述的經濟與大環境變遷而受到影響。面對全民健保的制度變化以及政府政策的規劃與實施，再加上因人口的年齡結構改變，逐漸進入老齡化社會，對醫療服務的品質要求提高，除了對於醫院推出的自費醫療項目接受度日增，護理機構的需求亦日漸提高，各級醫療機構不得不進行結構與策略上的調整來因應市場上的變化。本研究整理近期有關國內醫療與醫院產業的研究資料，用以了解並討論國內醫院產業環境的演變、現況以及未來的發展趨勢，其中包括了各級醫院的形態及結構上的改變，還有醫院如何發展以增加在市場上的競爭力。文中挑選較具代表性的公立及私立院所來進行比較分析，用以說明國內醫院產業在近幾年以來的變化，也能同時了解到各類型醫院的現況及未來發展走向；尤其是在組織結構的改變，以及醫療院所的型態改變，藉以了解國內的醫療院所如何演進以提升市場競爭力。經過比較與分析研究，可以得到以下的結論：我國的醫院產業與世界其他各國一樣，屬於受高度管制的產業，受到各項醫療法規與行政命令的嚴格監督，有趣的是，產業的發展脈絡，與一般的產業並沒有太大的不同。一般狀況下，產業要持續發展壯大，在企業管理的基本觀念中，有兩個主要的策略可以考慮，分別是規模經濟與範疇經濟。在醫院產業之中，規模經濟策略方向，將會以合併(併購)、委託經營、策略聯盟及增(擴)建院區等方式來擴大本身規模，將成本分攤的基數擴大，在不增價或是少量增加成本的狀態下，提高效率及利潤率。至於範疇經濟策略，則是依據醫療院所本身的條件與能力，橫向衍生發展自費項目，採行多角化經營的模式，以資源共享方式來控制成本，提高收入創造利潤等方式來強化財務。

關鍵字

產業經濟；醫院產業；醫院發展；規模經濟；範疇經濟

並列摘要

In recent years, countries with a certain degree of economic development have a common trend in their demographic changes, that is, the birth rate of newborns has declined, which has caused the stagnation (even negative) of population growth in some countries. Using the services provided by the United Nations website to count the changes in the population of the world every five years, from the results of this statistics to compare the trend of population changes in China, we can find great reference value. Since the Second World War, Taiwan's economic strength has gradually increased. Since the development of the country to the developed country, regardless of political controversy, the change in population growth rate is almost in line with the statistical results of countries around the world on the UN website. Taiwan's economy has developed rapidly in the past few decades, and the standard of living of the Country has improved, and the medical environment has also made substantial progress. The advancement of the medical environment and industry has made many solutions for diseases that are difficult to treat or cure in the past, and the improvement of national living standards has also reduced the chances of accidents. Therefore, the main reason for the current medical treatment of people has gradually turned into cancer. Mainly related to other chronic diseases, and due to the improvement of the economic and medical environment, the average life of the people has increased, resulting in changes in the demographic structure, and the social structure is developing towards aging. In response to this trend change, in addition to the already-run National Health Insurance, the Department of Health and Welfare (then the Department of Health) promoted the “Health Care Appreciation Platinum Program” in 2009 with the aim of improving China’s medical care system through substantial investment. It is expected that in the four years after the promotion, the output value of the medical care system will increase by 346.4 billion Taiwan dollars, and at the same time increase the employment opportunities of 310,000 people. While activating the domestic industrial environment, it will also drive the employment market and achieve the result of one stone and two birds. The domestic hospital industry has also been affected by the above-mentioned changes in the economy and the environment. Facing the changes in the system of universal health insurance and the planning and implementation of government policies, coupled with the age structure of the population, gradually entering the aging society, the quality requirements for medical services are improved, in addition to the acceptance of self-funded medical projects launched by hospitals. As demand increases, the demand for nursing institutions is increasing. Medical institutions at all levels have to make structural and strategic adjustments to respond to changes in the market. This study collates recent research materials on domestic medical and hospital industries to understand and discuss the evolution, current status and future development trends of the domestic hospital industrial environment, including the changes in the morphology and structure of hospitals at all levels, as well as hospitals. How to develop to increase competitiveness in the market. The paper selects more representative public and private institutions for comparative analysis to illustrate the changes in the domestic hospital industry in recent years, and also to understand the current status and future development of various types of hospitals; especially in the organization. Structural changes, as well as changes in the type of medical institutions, to understand how domestic medical institutions are evolving to enhance market competitiveness. After comparison and analysis, the following conclusions can be drawn: Taiwan's hospital industry, like other countries in the world, belongs to highly regulated industries and is strictly supervised by various medical regulations and administrative orders. Interestingly, the development of the industry is not much different from the general industry. Under normal circumstances, the industry must continue to grow and develop. In the basic concept of enterprise management, there are two main strategies that can be considered: economies of scale and scope. In the hospital industry, the direction of scale economy strategy will expand its scale by means of merger (M&A), entrusted operation, strategic alliance and increase (expansion) of the construction area, and expand the base of cost sharing without increasing the price. Increase efficiency and profitability with a small increase in cost. As for the scope economy strategy, it is based on the conditions and capabilities of the medical institution itself, horizontally deriving development of self-funded projects, adopting a diversified business model, controlling costs by means of resource sharing, and increasing income to create profits to strengthen finance.