臺灣博碩士論文加值系統

台灣人口正逐步邁入高齡老化中，而近幾十年來出生率持續下降，少子化與人口高齡老化已對人口結構帶來重大的改變。健保制度雖然得到大部分國人的肯定與支持，但是，健保財務卻潛藏著諸多的隱憂。此外，新醫療科技的引進、民眾醫療需求的增加，均使台灣醫療界面臨財務困境與危機的窘境。

目前台灣的資通訊產業非常發達，整體資通訊環境建設完備，有足夠能力發展遠距醫療照護體系。醫療的藍海應是以創造病人的最大價值為目的，而價值所指的是每一分錢所換得病人的康健結果。居家遠距照護是一項結合科技、通訊與醫療技術的照護模式，運用遠距監控技術，使高齡者能就近在居家或社區環境中，獲得保健、醫療、安全等無微不至的關照；目前世界各國正積極發展「遠距照護」，此亦應成為我國政府重視的問題。

透過對國內外遠距醫療照護產業相關文獻之回顧與分析、實際瞭解國內醫療現況與對國內推動遠距醫療照護計畫之探討後，本研究之目的，即在深入研究國內首例經由私人企業投資支持的居家遠距醫療照護個案，分析其創新之商業模式，進而探討其未來永續經營之遠景。

目前遠距醫療已被廣泛採用於: 慢性病照護、基本內外科照護、小兒科照護、心血管照護、精神科照護、產科照護、骨科照護、神經科照護、新生兒照護、與復建照護上。對於產業介紹，本論文從三方面著手：(一)國外模式， (二)國內模式， (三)萬芳醫院模式：含(1) 社區式遠距照護、(2)居家式遠距照護、(3)機構式遠距照護，與(4)未來整合式的照護模式。

本研究係採個案研究方法來進行，因此我們嘗試針對本個案之研究動機與目的，進行文獻的回顧、並以現有管理學理論對個案商業模式進行分析驗證，以嘗試建立個案未來長期營運之遠景。

在個案分析方面將依：(1)財務分析，(2)商業模式分析，(3)商業模式策略管理，(4)個案核心競爭力，(5)關鍵成功因素，(6)個案SWOT分析，(7) Porter五力分析架構，(8) 價值網(Value Net)分析等分析理論進行探討。最後分析個案營運之可能困境與未來可能之經營模式。

本個案營運之可能困境，包括：(1)建商住戶銷售率； (2)購買住戶如係純投資戶，買而不入住，將影響後段之客戶群來源； (3)面對台灣密度極高之基礎醫療網，在客戶就醫十分方便的情狀下，民眾自費參與居家遠距護之意願料將不會太高。(4)現行醫療法規範，醫師非親自看診不得為病人做治療處置，將限制遠距照護之發展；(5)照護產品、照護機構與服務品質尚未納入評鑑考核。(6)需納入全民健保給付，才能使此遠距照護產業更有發展空間。

本個案未來可能發展之經營模式，包括：(1)適度修改醫療法以擴大遠距醫療之服務層面：(2)醫療監控端可能合併網路平台端，而完全由醫療院所獨立經營；(3)付費端將由健保局、互惠者(保險公司或公司機構)付費，或由有需求之客群自費支付。

從本個案之研究，得到以下結論：(1)本個案係國內首家由私人企業投資結盟組成，所以在財務運作上甚具空間與彈性，且營運風險相對減少。(2)經財務分析後，得知本居家遠距照護個案，對於結盟之三家業者均深具獲利空間。(3)為求本個案永續經營之遠景，需創造價值網品牌、建立模仿障礙、持續創新經營模式。(4)本個案結合國內產、官、學三大領導品牌，三家公司在各自專業領域均甚具核心競爭力與品牌價值。(5)從需求與競爭分析中知，本個案之關鍵成功因素具有龐大的市場需求、首動優勢、 與優越的創新研發能力。(6)本個案經SWOT分析知，甚具競爭優勢、且逢國內高齡少子化時代來臨、健保財務持續惡化時，大有可為。(7)經五力分析知：從水平競爭中，本個案具有優良的品牌價值與首動優勢；而在垂直議價力上，本個案仍甚具競爭優勢地位。(8)從價值網分析中知，結盟的建商、技術院、醫院三者事實上是價值網內的互為互補者。

The age of people in Taiwan becomes older. The birth rate decreases in recent decades. These two major trends have changed the people structure in the country. Although the national health insurance satisfies most of the people, the financial crisis is now the major threat to the country. Moreover, the introduction of modern medical technologies and the increasing demands for medical services nowadays have made the financial crisis worsen in the country.

The information communication industry develops prosperously in Taiwan. The infrastructure of information communication has been well constructed. It is well prepared for developing telemedical care system in Taiwan. The blue ocean of medical service is to create the most treatment value for patients. This value is to get the best health outcomes per dollar spent, as Porter’s speech for the 20th Anniversary of TSMC in Taiwan. Home telecare is a new model of medical care combining of technology, communication and medical techniques. Using the telemonitoring technology, the aged can enjoy a more convenient, comfortable and safe medical service at home or in community environment. Since home telecare has been applied worldwide, the government of this country should focus more attention on such a sociomedical issue.

All the current literatures from the national and international resources have been reviewed. The current projects of telecare supported by government have been studied. The purpose of this study is to investigate the first home telecare case supported by a private entrepreneur, analyze its innovative business model and discuss its future vision.

Telemedical service has been applied to many medical fields, as in chronic disease care, basic cares for general medicine and surgery, pediatric care, cardiovascular care, psychiatry care, obstetric care, orthopedical care, neurological care, neonatal care, and rehabilitation, etc. The current status of telecare models is discussed in the following: 1. the international modes, 2. the national models and 3. the Wan-Fan Hospital mode. The most major project supported by the government in home telecare is currently conducted by Wan-Fan Hospital. The proposal contains home telecare model, community telecare model, institution telecare model and the future integrated model.

This study is conducted by case study. To correspond to the motivation and purpose of the study, literatures have been thoroughly reviewed. The business model of the case have been verified by the financial, strategic, and competitive analysis. The core competence and key success factors, SWOT analysis, Porter’s five forces and value net analysis have been applied consecutively also. The possible difficulties for operation and the future vision are discussed finally.

The difficulties in operation are: 1.The sale rate of the house, 2. The investor who not resides will reduce the case number. 3. The dense medical net of the country decreases the telecare will. 4.The medical regulation prohibits treating a patient without face to face examination. 5. Medical devices, hospital and service quality are still not be certified. 6. The national health insurance payment will promote the distribution of telecare.
The future model of the case comprises the following features: 1.To revise the medical regulations will expand the scopes of telecare. 2. The medical monitoring section will replace the information communication section. 3. The fee section will be paid by the national health insurance, private insurance, company, or by the patients.

The conclusions of this study are: 1. There is financial flexibility and less operational risk for such an entrepreneur-invested business model (construction company, technology institute and medical center). 2. There is a beneficial mutuality among these three allied corporates. 3. To create a valuable brand name, to set an imitation barrier, and to create an innovative business model are essential for the perpetual operation of this case. 4. These three allied corporates own core competence and brand value, are leaders in their fields. 5. The potential market demands, first mover advantage, and innovative creativity are the key success factors of the studied case. 6. The competition advantage and engorging market are the strength and opportunity of the case. 7. The competitive advantage in the five forces analysis are brand name, first mover, and better bargain ability. 8. The three allied corporates are in fact the mutual complements in the value net.

目 錄
口試委員審定書………………………………………………………… I
誌謝……………………………………………………………………II
中文摘要………………………………………………………………III
英文摘要………………………………………………………………VI
目 錄…………………………………………………………………IX
圖目錄…………………………………………………………………XIV
表目錄…………………………………………………………………XVI
第一章 緒 論…………………………………………………………1
1-1研究背景 ………………………………………………………1
1-1-1人口結構變遷……………………………………………………1
1-1-1-1人口老化……………………………………………………1
1-1-1-2少子化 …………………………………………………1
1-1-1-3與國際比較 ……………………………………………2
1-1-2 醫療現況…………………………………………………………5
1-1-2-1 全民健保……………………………………………………5
1-1-2-2 財務隱憂……………………………………………………5
1-1-2-3 老化與重傷…………………………………………………6
1-1-3 科技產業…………………………………………………………8
1-1-3-1 資通訊產業…………………………………………………8
1-1-3-2 兩兆雙星…………………………………………………...8
1-2研究動機……………………………………………………………9
1-2-1醫療藍海………………………………………………………9
1-2-2醫療體系價值…………………………………………………10
1-2-3遠距醫療概念…………………………………………………11
1-3研究目的……………………………………………………………11
第二章文獻探討………………………………………………………12
2-1文獻來源與範圍……………………………………………………12
2-2文獻回顧……………………………………………………………12
2-2-1 名辭定義……………………………………………………12
2-2-2 歷史回顧……………………………………………………14
2-2-3 遠距醫療之架構模式………………………………………15
2-2-4 遠距醫療之優劣勢…………………………………………17
2-2-5 遠距醫療之現況……………………………………………18
2-2-6 遠距醫療之遠景……………………………………………22
第三章研究架構與方法………………………………………………24
3-1研究方法……………………………………………………………24
3-2論文結構……………………………………………………………24
3-3研究限制……………………………………………………………25
3-4研究流程圖…………………………………………………………26
3-5理論架構圖…………………………………………………………27
第四章產業介紹………………………………………………………28
4-1國外模式……………………………………………………………28
4-1-1國外遠距醫療照護之沿革……………………………………28
4-1-2 世界各國發展現況…………………………………………30
4-1-3居家遠距醫療產業發展趨勢…………………………………34
4-1-4未來前景………………………………………………………35
4-2國內模式……………………………………………………………36
4-2-1 國內遠距醫療照護發展沿革………………………………36
4-2-2數位健康應用技術發展流程…………………………………40
4-2-3國內健康照護產業之發展現況…………………………………41
4-2-4健康照護創新服務之研究現況…………………………………43
4-2-5萬芳醫院模式……………………………………………………46
4-2-5-1計畫目標………………………………………………46
4-2-5-2計畫架構………………………………………………47
4-2-5-3計畫內容………………………………………………49
4-2-5-3-1 社區式遠距照護…………………………………50
4-2-5-3-2 居家式遠距照護…………………………………52
4-2-5-3-3 機構式遠距照護…………………………………54
4-2-5-4未來整合式的照護模式………………………………55
4-2-5-5遠距照護資訊平台……………………………………57
4-2-5-6遠距照護的預期效益…………………………………57
4-2-6台灣遠距照護發展的限制…………………………………58
4-2-7未來展望……………………………………………………59
第五章研究主題與個案分析…………………………………………61
5-1個案介紹……………………………………………………………61
5-1-1運作模式………………………………………………………61
5-1-1-1服務對象…………………………………………………61
5-1-1-2服務模式…………………………………………………61
5-1-1-3服務內容…………………………………………………62
5-1-1-4服務流程…………………………………………………64
5-1-1-5服務聲明…………………………………………………70
5-1-2 生理監測儀器………………………………………………70
5-2個案商業模式分析…………………………………………………72
5-2-1 財務分析……………………………………………………72
5-2-2 運作模式分析………………………………………………74
5-2-2-1病人端…………………………………………………75
5-2-2-2醫療監控端……………………………………………75
5-2-2-3網路平台端……………………………………………77
5-2-2-4 生理監測儀器產業…………………………………78
5-2-2-5 付費端………………………………………………79
5-2-3 商業模式策略管理…………………………………………80
5-2-4個案核心競爭力………………………………………………81
5-2-5關鍵成功因素…………………………………………………81
5-2-6個案SWOT分析………………………………………………83
5-2-7 Porter五力分析架構………………………………………85
5-2-8 價值網(Value Net)分析……………………………………86
5-3個案營運之可能困境………………………………………………87
5-4個案未來可能經營模式……………………………………………88
第六章 結論與建議……………………………………………………90
6-1研究結論…………………………………………………………90
6-2研究貢獻…………………………………………………………91
6-3未來研究方向建議………………………………………………92
參考文獻………………………………………………………………93

圖目錄

圖1-1. 民國95年與140年（預估）年底台灣人口年齡結構………4
圖 1-2. 價值創新：藍海策略基石……………………………………10
圖 2-1. 遠距醫療的架構模式………………………………………16
圖 3-1. 研究流程圖 …………………………………………………26
圖 3-2. 理論架構圖…………………………………………………27
圖 4-1.台灣全島遠距醫療先導實驗計畫……………………………38
圖 4-2.台灣遠距醫療網路架構之現況………………………………39
圖4-3. 我國數位健康應用技術發展歷程……………………………40
圖 4-4. 遠距照護試辦計畫架構……………………………………48
圖 4-5. 遠距照護試辦計畫服務團隊………………………………48
圖 4-6. 社區式遠距照護應用模式…………………………………51
圖 4-7. 居家式遠距照護應用模式…………………………………53
圖 4-8. 機構式遠距照護應用模式…………………………………55
圖 4-9.未來整合式的照護模式………………………………………56
圖4-10. 遠距照護預期效果…………………………………………58
圖 4-11. 遠距醫療與區域緊急救護網整合示意圖…………………60
圖5-1. 遠距照護服務模式……………………………………………62
圖5-2. 遠距照護服務架構……………………………………………64
圖5-3-1∼6.遠距照護服務流程…………………………………65-69
圖 5-4.生理監測儀器…………………………………………………71
圖5-5. M醫院商業模式-財務分析…………………………………73
圖 5-6.居家遠距照護商業模式。……………………………………74
圖 5-7.本個案之call center小組……………………………………75
圖5-8.Call center管理畫面……………………………………………76
圖5-9.會員管理畫面…………………………………………………76
圖5-10. M醫院堅強的醫療支持團隊………………………………77
圖 5-11. 商業模式策略控制…………………………………………80
圖 5-12. 個案之關鍵成功因素………………………………………82
圖 5-13. 波特五力分析架構原………………………………………85
圖5-14. 六力分析架構………………………………………………87
圖 5-15.遠距照護未來可能商業模式………………………………89

表目錄
表1-1 台灣老人人口限況與未來預估值 ……………………………3
表1-2中華民國台灣95年至140年人口推計……………………………3
表1-3.各國保險費率比較…………………………………………………6
表1-4.世界各國醫療支出占國內生產毛額之比率……………………6
表1-5.健保總額費用成長率……………………………………………6
表1-6.中央健保局現金基礎財務收支概況………………………………7
表 4-1.我國健康照護相關產業之發展現況…………………………43
表 4-2.我國健康照護研究計畫之推展現況…………………………45
表 4-3.遠距照護試辦計畫服務對象與內容…………………………49
表5-1.本個案之SWOT分析…………………………………………84

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