自費型醫療價值鍊行銷分析

Value Chain Analysis of Self-funded Medical Care

劉晟耀(Chen-Yeo Liu)

指導教授 ： 游張松

國立臺灣大學/管理學院/商學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.00145

摘要

從醫療保險體系介入醫療服務產業開始，台灣的醫療產業從市場機制上開始大幅轉變，而健保局在這個歷程中扮演主要的整合角色。就攸關全民健康的醫療保健上，健保局以社會政策為前提，企圖提供全體國民無論貧富都能享有高水平的醫療服務。在財務面上健保局卻企圖以保險體系的架構，透過市場機制解決醫療服務的收支平衡。
自費醫療或部分負擔可以適當的降低社會保險中政府的負擔，而政府可藉由法令的規定控制適當的市場秩序，民眾除以個人所得或儲蓄支付自費醫療或部分負擔，尚可依據個人對風險管理的偏好選擇其他私營型保險契約以規避不可預知的醫療費用。但健保局以”消極開源•積極節流”的方式面對健保財務壓力，以保守策略規劃自費醫療項目，將醫療財務平衡的壓力轉嫁給醫院經營者，進而迫使醫院型態由服務業導向轉向製造業導向，醫師成為生產線員工，專業能力的價值被破壞。醫療廠商減緩新技術的導入速度，國內醫療水平與國外技術落差擴大。
本研究以行銷理論中之價值鏈理論、服務價值理論、代理關係理論檢視現行的健保給付體系與自費體系，所導引的結論包括健保引發的價值鏈反應會嚴重阻礙價值鏈間的價值傳遞，造成整合價值破壞，價值鏈間的服務認知差距因為健保的設計產生擴大效應，而健保形成的多層次代理關係也會加劇代理風險與代理損失。
利用自費療程的個案調查，以供給面及需求面的質化與量化指標分析。本研究認為自費導向的醫療服務能創造合理市場機制，改善價值鏈與代理關係的問題。只要配合適當的管理機制，從國家政策、健保執行策略進行改善，加上公平開放的資訊平台，提供民眾較佳的認知權利。應該能創造出較適合自費導向的醫療環境。使民眾享有更多的醫療選擇權利，醫院取得較大的經營空間，而醫師的專業能力也能充分發揮，國內醫療水平也能加速提昇。

關鍵字

價值鍊 ； 醫療 ； 自費型 ； 行銷

並列摘要

Ever since the medical insurance framework was introduced to the medical service industry, Taiwan’s medical service industry has undergone enormous changes, with the most notable in its market mechanisms. During the process, The Bureau of National Health Insurance (BNHI) plays the primary role of integrating the system. With respect to medical and health care that concerns our citizens’ health, the BNHI takes the government’s social policy as the ground rule and attempts to provide premium health care services that benefit to all social classes. However, in relation to the financial scheme, the BNHI has attempted to achieve a balance between revenue and expenditure by utilizing the market mechanisms through the framework of the insurance system.
Adopting self-funded medical care or co-payment by patients may appropriately ease the government’s financial burden. The government can properly control the self-funded medical item by setting regulations. Other than paying from their own pocket, patients have the option to select private health insurance to hedge unexpected medical expenses according to their own risk preferences. However, the NBHI has chosen to confront its financial pressure from the NHI(National Health Insurance), by adopting the “Passive in broaden sources of income & Active in Cost down” approach and opted for a conservative strategy in planning the self-funded medical items. The NBHI has practically offloaded the pressure of finance of NHI to medical institution, forcing the hospital to shift from a service-oriented business to one that is manufacturing-oriented. Doctors become the production operators and the values of their professional skills are eroded away. Medical care suppliers are observed to slow down the introduction of new technology, resulting in an increasing gap between Taiwan’s medical care standards and those of foreign countries.
This study adopts the value-chain theory, service-value theory, and agency-relationship theory related to marketing study to review the pros and cons of the existing national health insurance program as opposed to a self-funded program. The conclusions derived from this study include: the value-chain reactions caused by the national health insurance program will severely impede the delivery of values in the value chains, which will in turn damage the integrated values. The service expectation gap in the value chains will expand as a result of the health insurance program’s design. In addition, the multi-layer agency relationships formed under the program will also intensify agency risks and losses.
In this study, we have conducted case studies on self-funded medical treatments by using qualitative and quantitative indicator-based analysis from both the supply and demand side. This study considers that self-funded medical services are able to create reasonable market mechanisms and improve the value-chain and agency-relationship issues. A more proper self-funding oriented medical environment is more likely to result provided that there is a proper administration mechanism in place, government policies and the implementation strategies for health insurance are made and that a fair and open information network is available allowing citizens to gain better understanding of their rights. Citizens will then able to enjoy more medical service options, the scope of operation for hospitals will be enlarger, doctors will be able to exert their full potential and the standards of national medical care services may be elevated rapidly.

並列關鍵字

Medical Care ； Value Chain Analysis ； Self-funded

參考文獻

7. 李玉春：全民健保多元支付制度之規劃及推動。於「21世紀管理發展趨勢國際學術研討會…」89.1摘錄本第156-179頁。

1. Kotler P, “Marketing management”, Analysis, planning, implementation, and control” New York 1994, pp 464

2. Regan, W.J. “The service revolution” Journal of Marketing, Vol27, 1963 pp32-36

5. Grossman, M.〝On the Concept of Health Capital and the Demand for Health〞, Journal of Political Economy, Vol.80, 223-255,1972

6. Crawford， J. C. and Getty， J. M. “The Marketing of Services: A Quality Perspective，” Journal of Professional Services Marketing， Vol. 8， No. 1， 1991， pp5-15