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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Slide,33,Chapter 5 - - How HSs Are Organized,How Health Systems Are Organized,Not all linkages among HSOs are established for the purpose of creating HSs. Linking to form HSs is only one,interorganizational relationship (IOR),that HSOs establish and maintain with other entities.,The wide variety of resulting HSs: relatively,simple,arrangements many HSOs result in a,large, complex,HS that is capable of providing a continuum of health services in its market,Two overarching aspects,p223,Interorganizational Relationships.,p224,The most prevalent type of IOR are involved is the,market transactions,between them and other entities. It can ensure markets for its services through IORs with insurance companies, managed care plans, employers, or groups of employers joined together in purchasing coalitions.,Involuntary IORs,Voluntary IORs: Strategic Alliances (SAs),Reasons to Ally.,p226,The external environments facing many independent HSOs have grown increasingly difficult, turbulent, and challenging.,Managed Care Organizations: integrate the financing and delivery of health services,MCO provide the coverage health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.,Approaches to Understanding SAs,.,p227-p235,Three interrelated perspectives:,Participants,Physician-Physician,Physician-HSO/HS,HSO-HSO,Purposes,Cost reduction,Revenue enhancement,Forms,Co-opting,Loose Coupling or Coalescing,Mergers and Consolidations,整合路徑,1,政策導向,強制執行,整合路徑,3,組織體認,學習、漸進,整合路徑,2,民眾導向,以人為本,全民健保,整合範例,醫療網計畫、,山地離島及原住民整合性照護計畫,醫療業者間進行整合，,如急性醫院附設居家照護單位、,醫院與基層開業醫整合等,醫療業者,(,組織,),內部管理、,資源及資訊共享,呼吸器患者整合性照護計畫、安寧照護整合性計畫、,及糖尿病人疾病管理,整合可能途徑,健康及醫療服務,分部,/,部門,業者,/,組織,區域,國家,醫療業的整合類型,醫療業者對整合性照護之詮釋,連續性,(,整合性,),照護之思維模型,傳統模式,階梯模式,同心圓模式,矩陣模式,疾病病程,醫,療,資,源,耗,用,急,/,重,康復,緩,/,輕,多,寡,階梯模式,日間照護,醫學中心,區域醫院,基層診所,檢驗所,社區藥局,慢性醫院,衛生所,小型醫院,護理之家,養護機構,安養機構,安寧照護機,居家照護,在宅服務,地區醫院,(,急性照護服務,),其他社會,福利與服務,群體執業種中心,同心圓模式,市場服務種類,(service mix),如基層照護、急性照護、長期照護等等,給付來源,(payment source),如健保、勞保、商保、自付等等,服務地點,(site),如醫院、診所、,護理之家等等,矩陣模式,連續性,(,整合性,),照護之思維模型,當代模式,電腦友善者使用模式,根源模式,滲透與開發,電腦友善者使用模式,根源模式,今日企業,顧,客,需,求,顧客種類,不,清,楚,清,楚,已接受服務,尚未接受服務,未開發的機會,未開發的機會,未開發的機會,Hamel & Prahalad,疾病預防,健康管理,疾病治療,疾病管理,滲透與開發,醫療業者之整合模式,原料供應商,(,原物料,),製造業者,1,(,製造,),批發業者,(,物流,),零售業者,(,銷售,),水,平,整,合,垂直整合,標的,組織,製造業者,2,(,製造,),向前或向下,垂直整合,向後或向上,垂直整合,製,造,業,之,供,應,價,值,鍊,Health Care Supply Chain,I,II,III,Aikman, Andress, Goodfellow, Labelle, & Porter-OGrady (1998),興起整合策略熱潮之因？,環境機會與威脅,組織優勢,整合策略,興起整合策略熱潮之因？,外在環境機會與威脅,經濟,文化 自然,政策 科技,人口,競爭者,供應商 顧客,社會大眾,組織,興起整合策略熱潮之因？,水平整合可創造的組織優勢,Operational efficiency,Minimize redundancy and duplication,Reduce number of competitors,Align and achieve strategic purposes among units,Promote channeling to flagship,Expand geographic coverage,Improve negotiating leverage with payers,Hurley, R.E.,興起整合策略熱潮之因？,垂直整合可創造的組織優勢,Control patient flow/lock-in market share,Solidify affiliation, particularly with physicians,Position to receive and distribute capitation,Pursue seamlessness across continuum of care,Offer alternative distribution and contracting options,Diversify revenue sources,Hurley, R.E.,國際之整合趨勢與借鏡,組織,價值 創造,(,機會創造與障礙克服,),是,否,競爭優勢,:,價值創造,符合消費者的需求,提高照護品質,改善財務狀況,放大市場定位,整合崩解,(Dis-integration),規劃 評估,回歸核心事業,成長、再評估,整合策略,I,整合策略,II,Service homogeneity?,常見問題-角色的衝突,醫療機構轉介關係選擇模式,1,A,診所,B,診所,C,醫院,A,診所,B,診所,夥伴關係,單向轉介關係,雙向轉介關係,病患由,A,診所及,B,診所 轉送,(,後送,),至,C,醫院,(,部分,),病患轉回至,A,診所及,B,診所,病患由,A,診所及,B,診所,轉送,(,後送,),至,C,醫院,醫療機構轉介關係選擇模式,2,A,醫院,B,醫院,C,醫學中心,A,醫院,B,醫院,夥伴關係,單向轉介關係,雙向轉介關係,病患由,A,醫院及,B,醫院 轉送,(,後送,),至,C,醫學中心,部分收入回歸,A,醫院及,B,醫院、部分病患轉送至,A,醫院及,B,醫院,病患由,A,醫院及,B,醫院,轉送,(,後送,),至,C,醫學中心,功能整合步驟,-,整合組織的運作內涵,參考,:,林妍如、萬德和，,2003,，,健康照護組織之價值創造：整合性照護之基本理念與設計入門,Stage setting,Trust build,Common vision created,Values clarified,Specific interests identified,Incentives,Interdependence,established,Economic effects of interdependence demonstrated,Data analysis,Market assessment,Patient origin,Market research into consumer preferences,Competitor profiles,Analysis of entry points,Medical staff profile,Organizational assessment,標準化,地方化,相互依賴與融合,二線臨床及行政管理,採購、工程、共同投資、,客服中心、服務專線、醫療糾紛、,品牌形象行銷、申報、契約管理、,疾病管理、個案管理、臨床照護指引、,病歷、資訊科技、教育訓練、研究、,品質管理,(,包括機構評鑑認證、,品質,/,績效指標建立及課責制度,),、,實證醫學、照護流程規劃,一線臨床管理,-,顧客服務,促進醫病溝通、縮短等候時間、,就醫環境指標清楚明確、,停車規劃、病患照護訊息 一致性、,治療處置清楚明確,顧客關係管理,針對不同消費者,(,如殘障者、孕婦、洗腎患者等,),進行人性化的就醫環境提供、個人化照護計畫、,院外居家追蹤、電子病歷的可近性、所需服務的可近性、,快速掛號、提醒物告知特定狀況,
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