創造病人價值為基礎之競爭理論在健康照護系統變革之分析-以眼科醫療為例

Analysis of Value-based Competition In Health Care Reform -Example of Ophthalmology Management

陳賢立(Henry Shen-Lih Chen)

指導教授 ： 劉順仁

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.2008.01068

摘要

台灣過去經濟的高度成長以及社會的快速發展，使得國民的健康需求跟著提升，而這些方面的引伸性需求-高品質的醫療服務需求也隨著大幅增加，醫療產業早已成為國家政策重要發展的一環。全民健康保險全面開辦後，醫療支付制度的改變，加上不斷增多的醫療院所間日益激烈的競爭，導致醫院的經營遭逢莫大的衝擊和挑戰。因而如何因應健康保險制度的變遷、制定有效的經營策略，便成為醫院經營團隊最重要的課題。
本研究擬以麥可、波特倡議的創造病人價值為基礎之競爭策略為主軸，探討在複雜多變的環境下，健康照護與醫療體系結構的如何變革，競爭及支付制度應以整體健康照護療程為中心，並主動適當的揭露相關績效資訊，如何提昇醫療品質而且必需植基於治療處置的成效與結果等議題。整體分析以醫療產業結構與經濟理論為基礎，然後以眼科醫療照護疾病、相關產業及創造青光眼患者價值之觀念架構為例，作深入的分析比較與建議。
本研究歸納分析認為，雖然創造價值為基礎之競爭策略在健康照護變革方面，仍然遭受許多質疑、批評與辯論，而或許波特的改革論述在不同的國家政策、文化背景、經濟狀況與健保制度情況下，也不一定能完整實施無礙；但是我們在考量並以提供高品質的健康照護服務及為病人創造價值的基本觀點來思考時，吾人建議醫療體系需進行正確形式，也就是正向循環，即正和(Positive sum)形式的競爭，同時由醫療提供者作出本身結構性的變革，如此將有機會使消費者、社會、健康計劃與醫療院所均可受益，亦即「多贏」的價值。

關鍵字

健康照護 ； 價值基礎 ； 競爭策略 ； 醫療品質

並列摘要

Resources to fund health care are finite, and there is an increasing demand from society and health care payers that clinical medicine should justify its use of scarce and valuable resources. As a result, the health care institutions continue to face a turbulent, confusing, and often threatening environment. Healthcare is undergoing a revolution today, a revolution of attitudes and expectations that is as inevitable as the industrial revolution. Cost control has emerged as a key issue for most countries' health systems and quality problems have recently emerged as another area of concern. Value-based medicine is the practice of medicine based upon the value (improvement in quality of life and/or length of life) conferred by medical interventions. As such, value integrates all of the benefits and adverse events associated with an intervention into the most probable outcome of healthcare. Value is also the perceived relationship between satisfaction and price.
Competition in health care is being widely considered as a policy approach to issues of cost and quality in many countries is often hotly debated, In Redefining Health Care, Porter described many of the medical failures which are due to the fact that we have the wrong kind of competition in health care. Health care competition is not focused on delivering value for patients. Instead, it has become zero sum: the system participants struggle to divide value when they could be increasing it.
Recent thinking on health care reform has migrated to improving quality and reducing medical errors. This is an exploratory research based on Porter's concept of competition is based on results of health care, and competition is centered on medical conditions over the full cycle of care. We analysis three medical conditions and draw the conclusion on the development and future prospects of health care industry.
In this study, we agree and conclude that the best way to truly improve patient value is to measure results: risk-adjusted outcomes relative to costs and we also suggest that the importance of value based competition is fundamental to both the care of individual patients and our understanding of the relationship between quality and outcomes of health care.

並列關鍵字

Health care ； Value ； Competition strategy ； Health insurance ； Medical quality

參考文獻

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