醫院創新服務的商業模式–以台灣某醫院遠距心臟照護為例

本研究之動機肇因於現今遠距照護雖被廣泛討論，但卻未被大規模例行性的應用，大部分遠距照護計畫，僅僅侷限在實驗或研究的階段，經費由公家單位支付，當計畫結束，經費告鑿，也就不了了之。因此，本研究認為遠距照護最重要的應是建立永續經營的商業模式，對病患、服務提供者、付費者，儀器廠商及國家社會才能發揮較大的效益，故本篇研究之目的為探討遠距照護可行之商業模式。本研究以台北地區某醫院(以下稱C醫院)為研究對象，針對其遠距心臟照護服務進行商業模式分析。進行方式為先以Michael E. Porter論述之產業競爭策略(1980)，競爭優勢(1985)進行文獻探討，之後描述C醫院於醫療產業之競爭態勢下，如何選擇競爭策略，接著針對商業模式(Business model)之內涵，要素，模型進行文獻整理，主要以Osterwalder and Pigneur (2004)歸結之商業模式本體論(Business model ontology)做為架構，解釋該院遠距照護之商業模式，最後以Schoemaker (1995)之情境分析方法(Scenario planning)描述商業模式之情境。分析結果顯示C醫院之商業模式，對於醫院管理團隊來說，能提供價值主張包括：核心能力的再強化，與競爭對手拉開差距，服務地理範圍延伸，接觸更多病患(通路擴張)，臨床照護品質提升，形象的提升，增加獲利來源。對於醫療團隊來說，能提供價值主張包括：提供即時心電圖以供診斷，給予正確的診斷，提高診斷的效率，提供的服務更完整，醫療專科發展更臻完備，獲得更多資源治療心血管病患。對於病患來說，能提供價值主張包括：得到健保未涵蓋的服務，降低心血管疾病猝死率，得到正確的診斷/縮短確診時間，可降低疾病總醫療支出，提升生活品質。本研究並提出二種可能的遠距照護模式：模式一：病患自費模式，由提供遠距心臟照護服務的醫院直接透過自身的通路尋求病患來源。模式二：為第三者付費模式，病患透過加入第三者的組織(如護理之家、安養機構)或成為客戶(如保險公司，或同儕醫院提供其他遠距照護服務項目，但未提供心臟照護，尋求互補之合作)，由第三者組織向遠距心臟服務的提供者(醫院)購買服務。財務方面，以C醫院進行遠距心臟照護之成本結構與收入計算，2007年平均每月虧損29萬元，若以60%的服務量成長估算，約5年可以損益兩平。本研究提出二階段之財務策略，第一階段先求擴大市場規模與佔率，第二階段再求損益平衡、有利潤。本研究並歸結下列幾點為遠距照護商業模式發展之結論與建議。1.遠距照護商業模式獲利可透過醫院內部的控管機制達成、2.公資源的投入與模式的改變可為達成經濟規模的方案、3.科技的運用與工具的選擇應以使用者為中心、並具備友善的介面、4.現今醫療制度下急性疾病的遠距照護市場較有可為、5.政府需進行資源整合、訂定明確方向並進行法規修改以利遠距照護發展、6.遠距照護可為國家長期照護人力不足之解決方案之一、7.遠距照護可形成新型態的國際醫療模式，促進國際間的醫院合作。

關鍵字

商業模式、遠距照護、遠距醫療

並列摘要

The motivation of the research was the phenomenon that the popularity of telecare and telemedicine programs was dramatically growing. However, there were few business applications found. Most telecare programs were either at the experimental or pilot study stage. Only few or none attempted to study proper business models. In this author’s view, the business model and the sustainable management were the crucial elements for telecare. Hence the purpose of this research was to investigate the possible business models for telecare. This research took one of the telecardiology service, which provided by one of the hospitals located at Taipei City, as example (hospital C). It firstly looked into the theories of Michael E. Porter’s competitive strategy (Porter, 1980) and competitive advantage (Porter, 1985). Then how the hospital C selected its competitive strategy and forming its advantage in the health service market were described. Then the paper searched for the features of business model, elements and structure were included. The research of business model literatures had a focus on the “business model ontology”, which was proposed by Osterwalder and Pigneur (2004). Next the “business model ontology” was applied in explaining hospital C’s telecardiology service. Finally the approach of scenario planning which suggested by Schoemaker (1995) was adopted in describing the possible situation of the telecardiology service. The result of the analysis revealed that the value propositions for the hospital management team are: empowerment of core competency, widening gap with competitors, expansion of market, more channels (to reach patients), improvement of quality of clinical service, improvement of hospital’s image and (possible) additional profits. The value propositions for the clinical team are: real-time ECG for accurate diagnosis, shortened period for diagnosis, improved cardiology service and more resources available for treating heart disease patients. The value propositions for patient are: the availability of services not covered by the national health insurance, reduced rate of sudden death, faster diagnosis, the cut of the expenditure on the heart disease and the improvement of life quality. This paper proposed two possible business models for telecare. The model one was the patients-paid model. In this model the service provider reached customers through its own channels such as OPD, IPD and ER service. The model two was the third-party-paid model. There were health insurers, nursing homes or telecare programs, provided by other hospitals, acted as brokers (the third-party payers) between the service providers and the patients. These brokers purchased service on behalf of their patients from hospitals (the service providers). In terms of the finance, the average monthly balance in 2007 was NT -290,000. It was estimated that based on the annual growth of 60%, it would take at least 5 years to reach the point of breaking even. This paper suggested two stages of financial strategy. The first stage was to expand the market and market share. The second stage was to break even and make profit.

並列關鍵字

business model, telecare, telemedicine

參考文獻

譚秀芬、吳明榮、曾泓富 (2004) “台灣遠距醫療未來遞送模式之探討”，中山管理評論，2004年中文特刊，第65-91頁

林淑霞、劉榮宏 (2009) “民眾對遠距照護產業之認知度與需求調查研究—以心臟病、高血壓及糖尿病為範疇”，未發表之問卷調查

Carlson, C.R., and Wilmot, W.W. (2006) Innovation. The Five Disciplines for Creating What Customer Want, Crown Business, Random House, New York

Chesbrough, H. and Rosenbloom, R.S. (2002) “The Role of the Business Model in Capturing Value from Innovation：Evidence from Xerox Corporation's Technology Spin-off Companies” in Industrial and Corporate Change 11(3):529-555

Cutchin, M.P. (2002) “Virtual Medical Geographies: Conceptualizing Telemedicine and Regionalization” in Progress in Human Geography, Vol. 26, pp.19–39

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醫院創新服務的商業模式–以台灣某醫院遠距心臟照護為例

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