台灣地區醫學中心多角化經營之策略

Diversification Strategy for Medical Centers in Taiwan

蒲永孝(Yeong-Shiau Pu)

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(2007年)

https://doi.org/10.6342/NTU.2007.10341

摘要

我國中央全民健康保險於民國84年開辦，民國91年起實施醫院總額預算支付制度，因醫療院所競相爭食健保資源，造成支付點值持續下降。從此台灣的醫療市場走向「高度競爭、低獲利率」的時代。各級醫療院所，尤其是公立機構，營運績效每況愈下，財務出現困難。政府又逐年減少公務預算補助，因此極需解決對策。

個案醫學中心在國內醫界居龍頭地位，其核心競爭力 (品牌、人才及追求卓越的組織文化) 及專業能力，國內有目共睹。但是卻未充分發揮這些競爭優勢，取得經濟利益。個案醫院亦為公立醫院，同樣遭遇財務困境，目前仰賴院內之業外收入（院內商場及停車場等）及公務預算補助，才得以免除赤字，發出績效獎金。為達”亞洲第一”的願景，個案醫院若不另闢財源，爭取資源，恐無法繼續發展與成長。因此本研究擬針對此問題，提出解決方案，並將個案醫院未來發展列入問題討論，分不同階段提出建議。

本研究採個案研究方式進行。欲解決的問題包括:
(1) 如何解決國內醫學中心的財務困難 (初期)
(2) 如何達成個案醫院之願景 (中期)
(3) 如何促使個案醫院發展成為永續經營的新醫療企業 (長期)

包括醫療產業在內，多角化經營策略，是企業化危機為轉機，改善財務狀況的方法之一。個案醫院過去僅有些業外經營，未有真正的大規模多角化經營。經營多角化事業，必須考量（1）品牌授權與否，（2）股權涉入程度，（3）技術轉移或管理支援程度。在競爭優勢分析上，應確立有那些關鍵成功因素，並應包括內部資源分析及外部競爭環境分析。

本研究在評估醫療產業大環境的變動，並考慮個案醫院的競爭優勢後，列出12大類的可能多角化經營方向，包括：
(1) 連鎖健診事業
(2) 連鎖專科醫療中心 (如: 美容中心、洗腎中心、復健中心等)
(3) 慢性療護機構 (如: 護理之家、老人安養或亞急性病中途之家等)
(4) 聯合檢驗中心
(5) 臨床研究委託機構 (CRO, Contract Research Organization)
(6) 健康雜誌或健康叢書文化出版事業
(7) 高級臨床訓練課程 (授予證書)
(8) 健康食品、醫療儀器用品店或藥?菮接?
(9) 生物技術開發公司
(10) 獨立私人醫療保險體系
(11) 建立醫療體系聯盟
(12) 國際醫療技術輸出

經文獻探討及個案分析，本研究認為: 個案醫院為適應國內醫療環境的改變，經營相關多角化事業，預期可以達到以下階段性目標:

(1) 初期目標: 改善財務狀況，以挹注醫療本業資源
以個案醫院之核心競爭力 (品牌優勢、人才、及追求卓越之組織文化) 及核心專業能力為主軸，進行相關多角化事業經營，以增加收入，改善財務狀況。

(2) 中期目標: 達到亞洲第一的願景
以多角化經營，財務改善後取得之資源，投入個案醫學中心研究、教學、服務之本業，並以個案醫院之品牌價值及影響力，整合及建構國內以個案醫學中心為核心的大型醫療聯盟體系，我們可以預期個案醫院，經由價值網絡及聯盟體系的建立，提高各多角化事業的市佔率，建立個案醫院在國內外醫療體系的實力，對整個大中華經濟圈或亞洲地區，會提昇其實質影響力，進而獲取國際認同及資源，使A1目標更易達成。

(3) 長期目標: 建立國際級大型醫療企業，奠定永續發展的基礎
以T大聯盟醫療體系為基礎，經營國際(以大陸及東南亞為主)多角化事業，例如: 海外分院，連鎖健診中心，國際臨床研究委託機構，醫療保險體系，國際生技公司等。建立一國際級多角化醫療企業，奠定永續發展的基礎。

關鍵字

醫學中心 ； 健康產業 ； 全民健康保險 ； 多角化 ； 核心競爭力 ； 附屬資產 ； 策略聯盟

並列摘要

The National Health Insurance was launched in Taiwan in 1995. Hospital global budget system was initiated in 2002. Because almost all health care facilities increased medical service amount, the reimbursed floating values appeared to decline gradually. The Taiwan’s health care business thus has become a highly competitive yet low profitable industry. The operating and financial performance of most health care facilities, especially those of public sectors, became deteriorating progressively. Worst of all, financial support from the government has been reduced over time due to the poor financial status of the government itself. It is thus urgent that the medical community find a way out of the crisis.

The focal hospital is a leading academic medical center in Taiwan, of which the core competitive strength (including the brand name, talent capacity and the culture of pursuing excellence) and the professional performance are well-recognized characters among all other medical centers. However, the competitive strength has not been fully explored. The focal hospital is in public sector which faced a significant financial distress in recent years. It is because of the non-medical revenue from businesses such as the market center, food court, and parking lot as well as the financial support from the government that the focal hospital can be devoid of a huge deficit and able to dispense rewarding bonus to its employees. To achieve the pre-determined institutional goal, ie. to be the leading university hospital in Asia, the focal hospital needs to explore more financial resources for its strategic development and growth. The study thus raised relevant questions and tried to provide solutions. The study also lists up potential directions of development of the focal institution at various stages.

This is a case study which is focused on the following three questions:
(1) How to deal with the financial distress of academic medical centers in Taiwan (short-term goal)
(2) How to achieve the pre-determined institutional goal (mid-term goal)
(3) How to transform the focal hospital into an ever-lasting new generation medical enterprise (long-term goal)

It has been shown that business diversification is one of major strategies that corporates including medical industry would take when they manage to turn a crisis into an opportunity and to improve their financial status. There have been a few everal examples of non-medical operations inside the focal hospital. However, there have been no actual large-scale diversified business operations. To diversify, it is imperative to take into consideration as (1) whether to authorize the use of brand name of the focal hospital, (2) whether to share the equity of the new business, and (3) whether and how to succeessfully transfer core technology and management skill. To identify key success factors for strategic strength analysis, it is crucial to include inner resources analysis as well as outer environmental analysis.

With an evaluation of the current trend of the health care industry and analysis of the competitive strength of the focal institution, the study herein suggests 12 categories of potential diversification as follows:

(1) Chain health checkup business
(2) Chain specialty care center (such as: plastic surgery and cosmetics center, dialysis center, rehabilitation center, etc.)
(3) Chronic care center (such as: nursing home, elderly insitituion, subacute care center, etc.)
(4) Combined clinical pathology and laboratory medicine business
(5) Contract Research Organization
(6) Publication service in medical and health care
(7) Advanced clinical educational courses
(8) Chain stores for health food, medical device, supplies and over-the-counter medicines
(9) Biotechnology firm
(10) Independent medical insurance system
(11) Construction of a focal-hospital-centered medical alliance
(12) International exportation of medical technology

After a thorough literature search and case analysis, the study suggests that to adapt to the current unfavorable environment, the focal hospital may, by way of related diversification, achieve the following goals:

(1) Short-term goal: To improve financial status and empower medical professions
Based on the core competitive strength (brand, talent, and the culture of pursuing excellence) and core professional technology, the focal institution may significantly increase revenue and improve financial performance by taking on diversified business.

(2) Mid-term goal: To become the leading hospital in Asia (A1)
By taking on diversification, the focal hospital can improve the financial performance and harvest adequate resources for improving its task on research, medical education, and clinical services. The focal hospital can also be able to construct a major medical alliance by exerting its impact on the domestic medical community, increasing the market share of its diversified business, and establishing a value network along the supply chain vertically and horizontally. The focal institution-based medical alliance can then emerge in the greater China and exert its influence on the regional community of Asia, obtain international recognition and resources, and march toward the A1 objective.

(3) Long-term goal: To build up an ever-lasting international medical enterprise
Once the domestic medical alliance is established, it can further extend its diversification investments into the greater China and Southeast Asia where operations may be focused on branch hospitals, chain health checkup business, contract research organization, medical insurance firm, biotechnology firms, etc. The establishment of the full-range business can then ensure an ever-lasting medical enterprise.

並列關鍵字

academic medical center ； health industry ； national health insurance ； diversification ； core competence ； complimentary assets ； strategic alliance

參考文獻

5. 莊逸洲、黃崇哲、鄭明智. 台灣醫院總額支付制度運作模式的初步探討. 醫務管理期刊 2003;4(3):1-17.

12. 彭彥瑋、陳柏元、彭朱如、林金賢、黃銘章. 醫院策略與環境外部配適對績效影響之實證研究. 醫務管理期刊 2005;6(4):399-428.

13. 陳柏元、彭彥瑋、林金賢、黃銘章、彭朱如. 競爭與合作策略--我國醫院策略、結構及資源之內部配適. 醫務管理期刊 2005;6(3):239-254.

23. 台大醫院企劃室內部網頁. 2006年12月.

29. 彭朱如、羅芳怡、許芳瑜、陳尚興. 醫院策略與產業競爭--理論模型分析. 醫務管理期刊 2002;3(1):1-25.