在健保總額下血液透析經營模式的動態競爭策略

林添松(Tien-Sung Lin)

指導教授 ： 江炯聰

共同指導教授 ： 張睿詒

國立臺灣大學/管理學院/商學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.10404

摘要

對於末期腎衰竭的病人，透析治療是目前維持生命最重要的治療。但隨治療成功生命延續，也帶來龐大醫療費用，而且死亡率的下降和人口老化等因素也使透析的醫療費用持續成長，成為公共衛生和社會福利的重大議題。
為了應對龐大醫療費用的成長，健保局採取總額給付浮動點值的政策，政策的改變也牽連整體醫療生態的變動，甚至整合成新的business model ，
因此本文從保險制度對人民就醫習慣改變，應用機會成本的觀念重新檢視末期腎衰竭病人的治療成本（包括直接醫療成本、罹病的社會成本、早逝成本、病人回歸社會的經濟效益）。
其次探討不同的成本結構或利潤池的影響，總額給付浮動點值對透析產業和醫療資源應用的影響，經營模式整合的原因和這些經營模式動態競爭下的最適策略和變化。
我們得到以下結論：
1. 比較2002年和2004年，可以看到在總額制度浮動點值確實降低透析病患直接的醫療支出，但在門診、住院和急診數量都明顯上升，是否透析降低的醫療支出，其實是來自醫院診所大總額（不含透析的總額）的彌補？或是其他與透析品質有關的因素？值得深思。
2. 末期腎臟病的病人是高醫療支出的疾病，而且付出高額社會經濟成本，因此如何預防末期腎臟病應該是努力目標。為了減少成本和支出，政府應該投入更多資源在慢性腎臟病照護網，效益較高的末期腎臟病前期處理。
3. 從直接療醫療成本和社會成本效益分析，提高透析品質、增加末期腎臟病的病人回歸社會和就業率，可以實質上減輕社會資源耗費，
4. 提高腹膜透析和腎臟移植比率，可以減少直接醫療成本和社會成本。政府在成本考量下，會是未來推動的治療驅勢，就不同經營模式者，應考慮其對血液透析的替代效應，儘速早考慮競爭策略。
5. 在總額浮動點值下，透析院所最大獲利或賽局的均衡的透析治療量，和變動成本成反比，和健保單次透析給付額成正比，和固定成本無關。
6. 在總額浮動點值下，營運模式會重新整合，醫師自營模式會向供應商垂直整合或醫師策略聯盟移動。
7. 差異化優勢會是未來競爭力重點，應該在學習和成長構面、組織內部的構面、顧客構面，形成新的差異化優勢。

關鍵字

血液透析 ； 經營模式 ； 競爭策略

並列摘要

The hemodialysis is the important treatment in the uremic ( ie : end stage of renal disease ) patients .The medical expense and cost will get increased followed the successes treatment .The expansions of medical expense make to be a theme for discussion in the insurance of health care .
The policy of total budget with floating payment by Health Insurance impact the ecological dispersion of clinics and hospitals . The change of policy resulted into new business models in the dialysis medical industry .
We try to discuss the influence of health insurance about patients 、 clinicss and hospitals , the different forced powers to the dialysis medical industry .We try to re-evaluate the medical cost 、the social economic cost and the social benefit in dialysis treatments for uremic patients by the view of opportunity cost . Then we try to analysis the cost construction of different business models . After analysis of SWOT and game theory , We try to make the strategy for the dialysis medical industry .
Our conclusions are as the following :
1. After comparison of medical cost between 2002 and 2004 , the dialysis expense got decreased after he policy of total budget with floating payment .But the charge of emergency care 、OPD and hospitalization got significant increased in the during time . The nature of event need more study .
2. We should put more resource into pre-uremic care . We should set up the chronic care network .
3. Maintain the good and adequate dialysis , make the social benefit about uremic patient return the work .
4. The peritoneal dialysis and transplantation can decrease the medical expense .The government will promote the treatments under the finical stress .We should modify our strategy to enter these fields .
5. Variable cost should to be the dominant factor to the competition of dialysis business models .
6. The integration of different business models will accelerate by the policy of total budget with floating payment .
7. Segmentation will be an important competitive strategy . We should re-design the our strategy maps .

並列關鍵字

Hemodialysis ； Business model ； Competitive Strategy

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