臺灣博碩士論文加值系統

論文提要
中文摘要

由於全民健康保險及總額支付政策的嚴格規定，無論是小型醫院還是大型醫學中心，現在台灣的醫療機構已經無法再進行很大的投資或得到更多收入。而醫療系統無法自傳統的大量生產之結構中脫胎換骨，更使得這樣的困境愈加複雜。大量訂製（Mass Customization）及聚焦工廠（Focused Factory）這些新觀念已被許多企業應用，而且極為成功，可以以低價格獲得高品質。這些新觀念可以帶來極大的顧客價值，讓企業可以在越來越競爭中得到品質及利益的改進。台灣的醫療機構可以利用這種以顧客為中心的轉型來增進滿足病人的需求，同時跨出全民健保的傳統限制。這些創新觀念與醫療理想非常相近。不過傳統的醫療概念及台灣的反對市場醫療政策，對於往此方向的改變及進展有極大的阻礙。這篇論文宣稱大量訂製及聚焦工廠可以有效的解決台灣醫療機構的問題。尤其是對小型專科地區醫院，可以利用這方式擷取新消費主義趨勢的益處，並讓自己變成更具有競爭力，為它的顧客創造更高的生命及健康價值。
這篇文章一開始為深入的介紹，以及台灣醫療系統及參與專科地區醫院的SWOT分析。在了解了這個市場之後，接著對於大量訂製及聚焦工廠的概念及引用進行相關文獻的探討。之後針對三個專科醫療機構進行個案比較研究，評估這些機構在競爭策略、行銷定位、管理績效、人力資源優勢及業績表現五方面的差異。這三個醫療機構包括一個傳統專科地區醫院（吉田耳鼻喉科醫院）、一個以單一手術為主的醫療機構（Shouldice醫院）、以及一個專精疾病管理的醫療連鎖醫院公司（MedCath公司）。最後進行全面性的討論，評估大量訂製及聚焦工廠觀念對於台灣醫療市場上的專科地區醫院之適用性。

關健字：大量訂製,聚焦工廠,專科地區醫院,台灣醫療市場

Abstract
English Abstract

From small hospitals to large medical centers, the Taiwan healthcare organizations today are unable to significantly increase investments or generate more revenue due to the strict regulations of current National Health Insurance and Global Budget policies. This predicament is further complicated by the healthcare system’s inability to change from its traditional mass production architecture and mentality. Mass customization (MC) and focused factories (FF) are being applied across many industries with great success – achieving quality at low cost. These are new concepts that can bring significant customer value, allowing organizations’ quality and profitability to improve from increasingly commoditized businesses. This consumer-centric transformation can be one way for Taiwan’s healthcare organizations to get closer to patients’ needs and step out of the traditional confines of the NHI and healthcare delivery. These novel ideas are so akin to the healthcare ideal, yet the traditional healthcare design and Taiwan’s anti-market healthcare policies effectively impedes changes and progress in this direction.
This paper intends to assert that MC and FF can be one effective solution to the problems in Taiwan’s healthcare organizations – specifically for the specialty community hospitals. In this way, these small hospitals can capture the value premiums of this new consumerism trend and transform itself into a competitive business, creating higher values for life and health for its customers.
This paper will begin with an in-depth background and SWOT analysis of the Taiwan healthcare system and its participants. After an understanding of this industry, a pertinent literature review of the MC and FF concepts and mechanics will be done. A case comparison study of three specialty healthcare organizations will be done to evaluate their differences in competitive strategy, marketing orientation, operational effectiveness, human resources advantage, and organizational performance. The three organizations include a traditional specialty hospital (Gee-Tien Ear Nose & Throat Hospital), a single procedure-based focus factory (Shouldice Hospital), and a disease management focus factory (MedCath Corporation). Finally, a full discussion will ensue to assess the applicability of FF and MC concepts for specialty community hospitals in the Taiwan healthcare market.

Keywords: Specialty Hospitals, Mass Customization, Focused Factory, Taiwan Healthcare

Table of Contents

Tables and Figures List 9
Acknowledgement 3
Abstract 5
中文摘要 4
English Abstract 5
Chapter 1 Introduction 10
1.1 Taiwan Healthcare Industry at the Crossroad 10
1.2 Healthcare Development in Taiwan 10
1.3 Obsolescence of the Mass Production Paradigm 12
1.4 The Mass Customization Concept 15
1.5 The Focused Factory Concept 16
1.6 Motives and Objectives for This Thesis 17
Chapter 2 - Taiwan Healthcare Market Overview and Specialty Community
Hospital SWOT Analysis 19
2.1 The Four Taiwan Healthcare Systems 19
2.1.1 Primary Care Clinics (PCCs) 19
2.1.2 Community Hospitals (CHs) 20
2.1.3 Regional Medical Centers (RMCs) 20
2.1.4 Teaching Medical Centers (TMCs) 21
2.2 Taiwan Specialty Community Hospitals and Their SWOT Analysis 22
2.2.1 Strengths 22
2.2.2 Weaknesses 22
2.2.3 Opportunities 23
2.2.4 Threats 23
2.3 Community Hospitals in the Taiwan Healthcare Market: Present
and Uncertain Future 24
Chapter 3 - Mass Customization 26
3.1 A New Age for Mass Customization 26
3.2 Continuous Improvement versus Mass Customization 28
3.3 The Solution Space 30
3.4 Customer Interaction and Product Configuration 31
3.5 Modular Capabilities 33
Chapter 4 - Focused Factory 35
4.1 Focused Factories as the Healthcare Organizations of the Future 35
4.2 Traditional Specialty Hospitals (SHs) 35
4.3 The Focused Factory Concept from Manufacturing 36
4.4 What Do Consumers Really Want from Healthcare? 37
4.5 Healthcare Focused Factories 39
4.6 Healthcare Focused Factories in Taiwan 40
Chapter 5–Research Methodology 42
5.1 Purpose and Rationale for Study 42
5.2 Research Question and Design 42
5.3 Comparison and Analysis Methodology 42
5.4 Data Collection 44
Chapter 6–Case Presentations 45
6.1 Case #1: Gee-Tien Ear Nose & Throat Hospital-A Traditional
Specialty Hospital 45
6.1.1 The Ear Nose & Throat (ENT) Market in Taiwan 46
6.1.2 Introduction to Gee-Tien 46
6.1.3 History of Gee-Tien Ear Nose & Throat Hospital 47
6.1.4 Facilities and Services 47
6.1.5 Organizational Analysis 49
6.2 Case #2 Shouldice Hospital – A Single Procedure Focused Factory 51
6.2.1 History 51
6.2.2 The Shouldice experience 51
6.2.3 Shouldice Treats Its Doctors Very Well 52
6.2.4 The Facility and the Administration 53
6.2.5 Let the Record Speak for Itself 53
6.2.6 Why Shouldice is so Successful 54
6.3 Case #3 MedCath Corporation – A Single-Disease Focused Factory 55
6.3.1 The Cardiovascular Market 55
6.3.2 The Business Plan of MedCath Corporation (MC) 55
6.3.3 MedCath Corporation at a Glance 56
6.3.4 Patients and Doctors Both Love MedCath 56
6.3.5 MedCath’s Cost Saving Advantages 57
Chapter 7 - Results Analysis and Comparison 58
7.1 Result Summary 58
7.2 Organizational Structure 59
7.3 Main Competitive Strategy Choice 59
7.4 Marketing Orientation 60
7.5 Operational Effectiveness 60
7.6 Human Resources Advantage 62
7.7 Organizational Performance 63
Chapter 8 - Discussion 65
8.1 The Taiwan Healthcare Crisis for Patients, Doctors, and Hospitals 65
8.2 Why the Focused Factory Paradigm is Superior 66
8.3 Mass Customization and Focused Factory Together 67
8.4 Specialty Hospitals of the Future 68
Chapter 9 – Summary 70
References 71

References
(1) Baldwin, Carliss Y., Kim B. Clark (1997) “Managing in an Age of Modularity.” Harvard Business Review, 75(5): 36-50.

(2) Canadian Health Coalition. “Shouldice Hospital: The Center of Excellence for the Repair of Abdominal Hernias.” Canadian Health Coalition Website. , accessed April 15, 2004.
(3) Casalino, Lawrence P., Kelly J. Devers, Linda R. Brewster (2003) “Focused Factories? Physician—Owned Specialty Facilities.” Health Affairs, 22(6). ＜http:// www.medscape.com/viewarticle/465268＞, accessed April 15, 2004.
(4) Center for Studying Health System Change (April 15, 2003) “Specialty Hospital Building Boom Threatens General Hospitals Competition Heats Up For Profitable Cardiac and Orthopedic Services”. Center for Studying: Health System Change Website.＜http://www.hschange.com/CONTENT/554/? PRINT=1＞, accessed January 7, 2004.

(5) Clarity Group, Inc. Consulting Services (2002) “Creating Consumer-Driven Healthcare Organizations: A White Paper.” Clarity Group, Inc. Website. <http://www. claritygrp.com/Consumer- DrivenWhitePaper_links_09.24.pdf>, accessed April 15, 2004.

(6) Czinkota, Michael R., Peter R. Dickson, Patrick Dunne, Abbie Griffin, K. Douglas Hoffman, Michael D. Hutt, John H. Lindgren, Jr., Robert F. Lusch, lllkka A. Ronkainen, Bert Rosenbloom, Jagdish N.Sheth, Terence A. Shimp, Judy A. Siguaw, Penny M. Simpson, Thomas W. Speh, and Joel E. Urbany (2000) Marketing: Best Practices. Fort Worth, TX: Dryden press.

(7) Devers, Kelly J., Linda R. Brewster and Paul B. Ginsburg (2003) “Specialty Hospitals: Focused Factories or Cream Skimmers?”Center for Studying: Health System Change Website. <http://www.hschange.org/CONTENT/552/>, accessed April 18, 2004.

(8) Drucker, Peter F. (2002) “They’re Not Employees, They’re People.”Harvard Business Review, 80(2): 70-77.

(9) Drucker, Peter E. (1990) “The Emerging Theory of Manufacturing.” Harvard Business Review, 68(3): 94-104.

(10) Feehan, Amy S. (2000) “From Medical Monoliths to ‘Focused Factories’ – Healthcare Takes a Cue from Wal-Mart.” Healthcare Informatics Online. <http://www.healthcare- informatics.com/issues/2000/04_00/apr00.htm>, accessed April 18, 2004.
(11) Gilmore, James H., B. Joseph Pine II (2000) Mass Customization: Creating Customer-Unique Value through Mass Customization. Boston: Harvard Business School Publishing.
(12) Gilmore, James H., B. Joseph Pine II (2000) Markets of One: Creating Customer—Unique Value through Mass Customization. Boston: MA: Harvard Business School Press.

(13) Gilmore, James H., B. Joseph Pine (1997) “The Four Faces of Mass Customization.” Harvard Business Review, 75(1): 91-101.

(14) Gilmore, James H., B. Joseph Pine II (2000) “Introduction: Customization That Counts.” In Market of One: Creating Customer-Unique Value through Mass Customization, eds. James H. Gilmore, B. Joseph Pine II. Boston: Harvard Business School Publishing, p.vii-Xxxv.

(15) Grove, Andrew S. (1999) Only the Paranoid Survive: How to Exploit the Crisis Points That Challenge Every Company. New York: Currency Doubleday.

(16) Herzlinger, Regina E. (1997) Market—Driven Health Care: Who Wins, Who Loses in the Transformation of America’s Largest Service Industry. Cambridge, MA: Perseus books.

(17) Herzlinger, Regina E. (2002) “Let’s Put Consumers in Charge of Health Care.” Harvard Business Review, 80(7): 44-55.

(18) Herzlinger, Regina E., Peter Stavros. (2002)“MedCath Corporation.”Harvard Business School Case No. 303-041. Boston, MA: Harvard Business School Publishing.

(19) Heskett, J. L. (1983) “Shouldice Hospital Limited.” Harvard Business School Case No. 683-068. Boston, MA: Harvard Business School Publishing.

(20) Kelly, Dennis I. “Federal Trade Commission Department of Justice Hearings on Health Care and Competition Law and Policy,” (March 27, 2003) <http://www.ftc.gov/ogc/healthcarehearings/docs/dkelly.pdf>, accessed April 15, 2004.

(21) Kotler, P. (2003) A Framework for Marketing Management. Upper Saddle River, NJ: Pearson Education Inc.

(22) Marietti, Charlene.“Nine Tech Trends.” Healthcare Informatics, (February 2002) ＜http://www.healthcare-informatics.com/issues/ 2002/02_02/cover.htm.＞, accessed January 7, 2004.

(23) McKenna, Regis (1988) “Marketing in an Age of Diversity.” Harvard Business Review, 66(5): 88-94.

(24) McTeer, Robert D. Jr. (1998) “A Letter from the President: Right Stuff: American’s Move to Mass Customization.” Federal Reserve Bank of Dallas Annual Report, pp. 1.

(25) MedCath Corporation Website. , accessed May 1, 2004.

(26) MedCath Hospital Locations. MedCath Corporation Website. <http://www.medcath.com/corp/images/ loc_map.gif>, accessed May 1, 2004.

(27) Miller, Julie, (2003). “Mass Customization Suits Varied Needs of Large Employers.” Managed Healthcare Executive, September 2003, , accessed April 15, 2004.
(28) Pine, B. Joseph, James Gilmore (1998) “Welcome to the Experience Economy”. Harvard Business Review, 76(4): 97-105.
(29) Pine, B. Joseph, Bart Victor, Andrew C. Boynton (1993) “Making Mass Customization Work.” Harvard Business Review, 71(5): 108-116.

(30) Pine, Joseph B. II (1999) Mass Customization: The New Frontier in Business Competition. Boston, MA: Harvard Business School Press.

(31) Pine, Joseph B. II, James H., Gilmore (1999) The Experience Economy: Work is Theatre Every Business a Stage. Boston: MA: Harvard Business School Press.

(32) Porter, Michael E. (1985) Competitive Advantage: Creating and Sustaining Superior Performance. New York: The Free Press.

(33) Schonfeld, Erick (1998) “The Customized, Digitized Have-It-Your-Way Economy.” Fortune. 138(6): 84-92.

(34) Shouldice Hospital Lecture Notes. <http://www.cercle-solvay.be/ges/docs/ inno_tech/Case%201%20-%20Shouldice.pdf>, accessed April 15, 2004.

(35) Shouldice Hospital Website. <http://www.shouldice.com>, accessed April 15, 2004

(36) Skinner, Wickham (1985) Manufacturing: The Formidable Competitive Weapon. New York: John Wiley & Sons.

(37) United States General Accounting Office (2003) “Specialty Hospitals: Geographic Location, Services, and Financial Performance.” Report No. GAO-04-167. , accessed April 15, 2004.

(38) 全民健康保險統計年報/91醫療統計年報. 2002. 行政院衛生署網站. <http://www.doh.gov.tw/statistic/data/全民健康保險統計年報/91醫療統計年報/9104.xls>, accessed April 15, 2004.

(39) 健保總額給付壓縮地區醫院, 台灣新聞報,中華民國九十一年七月二十四日.

(40) 蔡良敏, “健保總額給付壓縮地區醫院,” 中華民國地區醫院協會會訊, 中華民國九十一年八月三十一日, No. 20.