臺灣博碩士論文加值系統

本論文的主題為探討醫療保健產業中的價值鏈，及構成其價值鏈中的不同要素所扮演何種角色。此研究透過醫療保險制度在不同的國家中的同質性及其差異點之分析，來凸顯標準化之重要性。電子病歷(EMR)更是扮演著醫療服務創新的重要推手。本文也將研討醫療服務創新中最成功的典範 -- 醫療旅遊; 以泰國及印度這兩個國家為例，從中分析醫療旅遊的成功因素。研究結論則指出產業中的標準化將扮演價值鏈發展進化中最重要的角色，其重要性也影響著未來醫療旅遊在各個國家中的發展。

This thesis deals with Value chain of Health care Industry and its various components in the value chain. What are the standardization done till date. What are the various Health care plans in different countries and how they are related to health care insurance? From technology point of view what is Electronic Medical Record (EMR) and how the technology can use to boost future businesses with focus on Service innovation. With Health care Service innovation using several models in place, Medical Tourism is explored and what have other countries done and what has made two countries popular in this field, namely Thailand and relatively new entrant India. How standardization plays an important role throughout the value chain thus improving Medical Tourism ultimately.

ACKNOWLEDGMENT iii
ABSTRACT iv

Chapter 1 – INTRODUCTION 1
1.1 Motivation 1
1.2 Objectives 3
1.3 Research Methodology 3

Chapter 2 – LITERATURE REVIEW OF VALUE CHAIN OF HEALTH CARE 4
2.1 Health care 5
2.2 Innovation in Health care 6
2.3 Health care systems in various countries and role of governments 8
2.4 Coordination between players within the value chain and role of agency 11
2.5 Electronic Medical Records, Service innovations and Medical Tourism 12

Chapter 3 – VALUE CHAIN IN HEALTH CARE INDUSTRY 16
3.1 Value Chain – Michael Porter 16
3.2 The Extended Enterprise 19
3.3 Objectives of Value Chain 22
3.4 Supply Chain 24
3.4.1 Health care Supply Chain 25
3.4.1.1 Disaster Recovery 25
3.4.1.2 Supply Chain Integrity 26
3.4.1.3 Network Complexities 26
3.4.1.4 Disintermediation 27
3.4.1.5 Value Visibility 29
3.5 Health care systems 32
3.5.1 Characteristic of health care 32
3.5.2 Various Health care models 33
3.5.3 Health care plan in different countries 33

3.6 Health Insurance 40
3.6.1 Health Insurance Policy 41
3.6.2 Health Insurance Plan and Rates 42
3.6.3 Growth in Demand 45
3.6.4 Medicare and Medicaid in US 46
3.6.5 Expenditure of Medicare and Medicaid 47
3.7 Electronic Medical Record – EMR 48
3.7.1 EMR / EHR in use 52
3.7.2 Barriers to adopt and implement EMR / EHR 52


Chapter 4 – STANDARDIZATION OF VALUE CHAIN 56
4.1 Product Information Management (PIM) 58
4.2 Adoption of Industry-wide standardization 59
4.3 Health care Standardization Plan from Governments worldwide 62
4.4 Patient empowerment and technology advancement 62
4.5 Towards standardization 63

Chapter 5 – SERVICE INNOVATION IN HEALTH CARE 67
5.1 Service innovation models 68
5.1.1 Areas of Innovation - den Hertog’s Model 69
5.1.2 Miles’ approach 70
5.2 Medical Tourism 76
5.2.1 Introduction and Benefits 76
5.2.2 Role of Standardization and Service Innovation in Medical Tourism 79
5.2.3 Process in Medical Tourism 80
5.2.4 Medical Tourism in various countries 81

Chapter 6 – CONCLUSIONS, RECOMMENDATIONS AND FUTURE TRENDS 87
6.1 Conclusions and Future implications of the value chain 87
6.2 Recommendations 91
6.3 Limitations and Future research 95

[1] World Health Organization Report. (2000). "Why do health systems matter?". WHO
[2] CommonDreams.org - http://www.commondreams.org/archive/2007/09/07/3697/
[3] From Centers for Medicare & Medicaid Services
[4] Chheda, N. C. (2007). The Not So Short Introduction to Health Care in US.
[5] http://www.oecd.org/dataoecd/10/20/2789777.pdf
[6] Insuring America''s Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22
[7] Physicians for a National Health Program "International Health Systems"
[8] G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
[9] Herzlinger, R. E. (2006). Innovation in Health Care. Harvard Business School. 9-306-042.
[10] www.crossborderpharmacy.com - comparative prices for Premarin
[11] McFadden, C. D., et al. (2000). US Health care Distribution: Positioning the Health care Supply Chain for the 21st Century, Goldman Sachs.
[12] Fixing the Health care Supply Chain by Jonathan Byrnes (4/5/2004)
[13] Dyer, Jeffrey, Collaborative Advantage New York: Oxford University Press, 2000
[14] Health Insurance in Germany - MySME - Resources for Small Business in Germany in the English Language
[15] Health Service/Insurance Industry in Italy - http://www.ess-europe.de/en/italy.htm
[16] Practicing physicians per 1000 population, OECD countries, 2005
[17] Fanchiang and Cecilia (2004). "New IC health insurance card expected to offer many benefits." Taiwan Journal.
[18] Howstuffworks: How Health Insurance Works : Health Insurance
[19] Fundamentals of Health Insurance: Part A, Health Insurance Association of America, 1997, ISBN 1-879143-36-4
[20] Adapted from the IEEE definition of interoperability, and legal definitions used by the FCC (47 CFR 51.3), in statutes regarding copyright protection (17 USC 1201), and e-government services (44 USC 3601)
[21] Ringold, D., J. Santell, et al. (2000). "ASHP national survey of pharmacy practice in acute care settings: dispensing and administration—1999." American Journal of Health-System Pharmacy 57 (19)(1759-75).
[22] Walker J, Pan E, et al. (January 19, 2005). "The Value Of Health Care Information Exchange And Interoperability." Health Affairs. Web Exclusive.
[23] NAHIT Levels of EHR Interoperbility
[24] European Parliament and Council (24 October 1995): EU Directive 95/46/EC - The Data Protection Directive
[25] Medical Board of California: Medical Records - Frequently Asked Questions
[26] National Archives and Records Administration (NARA): Long-Term Usability of Optical Media
[27] National Center for Health Statistics: Electronic Medical Record Use by Office-Based Physicians:, United States, 2005
[28] CDC''s National Center for Health Statistics: More Physicians Using Electrical Medical Records
[29] Gans D, Kralewski J, et al. (2005). "Medical groups'' adoption of electronic health records and information systems." Health affairs (Project Hope) 24 (5): (1323-1333).

[30] New service development: a review of the literature and annotated bibliography
[31] Nijssen et al. (2006). "Exploring Product and Service Innovation Similarities and Differences." International Journal of Research in Marketing vol. 23 (doi:10.1016/j.ijresmar.2006.02.001): pp. 241 - 251.
[32] Edvardsson, B. and J. Olsson (1996). "Key concepts for New Service Development." The Service Industries Journal vol. 16: pp. 140 – 164.
[33] Edvardsson, B. (1997). "Quality in new service development: Key concepts and a frame of reference." The International Journal of Production Economics vol. 52: pp. 31 - 46.
[34] OECD (2006). "Innovation and Knowledge-intensive Service Activities
[35] http://www.proinno-europe.eu/index.cfm
[36] http://en.wikipedia.org/wiki/Knowledge_intensive_business_services
[37] Forfás (2006). "Service innovation in Ireland - Options for Innovation Policy
[38] Cetron, M. and F. J. DeMicco (2006). "Club Medic." Florida International University Hospitality Review (Final Review Copy).
[39] Government starting to accommodate medical tourism in visa policies
http://investintaiwan.nat.gov.tw/en/news/200704/2007042002.html

Other sources
http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm
http://www.hcfo.net/pdf/ppo.pdf
http://www.insurelane.com/health/hsa-overview.html
http://health.howstuffworks.com/health-insurance3.htm
http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm
http://medical-tourism.feedba.cc/live/story.cfm?storyID=1897