資通訊健康管理產業的商業模式研究 - 以遠距健康照護服務為對象。

Abstract

人口老化及少子化的趨勢造成台灣人口結構的快速改變，已經是無法避免的事實。台灣從1994年進入「高齡化社會(ageing society)」，65歲老人人口達148萬，佔總人口比率達7%¸，2012年65歲已達260萬佔人口比率11.2%。預估到民國2017年，65歲以上老年人口將達到13.67﹪，距離14%的「高齡社會(aged society)」只有幾步之遙。高齡社會除了意味著高齡市場及商機的擴大，也代表配合高齡(65歲以上又稱銀髮族)或是熟齡(50歲以上)的健康需求產品及消費量將持續增加。同時隨著戰後嬰兒潮世代(1945~1965出生，又被稱為「建造者(constructor)」)年歲增長，將陸續離開職場展開退休生活，這批為數眾多、被視為是創造財富也累積財富的退休人口，將成為這一世代消費實力雄厚的一群，被看好將引領帶動老人市場的需求，創造銀髮產業的商機。

面對此一情勢我們看到政府的健康及老人政策紛紛被提出，產官學也都積極的規劃及佈局在銀髮族及中高齡健康產業的發展及創新，試圖營造一個友善、有效的整合營運環境及功能性的服務平台。資通訊(Information and Communication Technology 簡稱 ICT)是資訊科技及通訊技術的合稱。近年來業者運用ICT平台提供遠端健康照護服務，這是傳統健康照護產業無法做到的服務。這一科技化的服務產業的興起，加上日新月異的科技進步，如近年來的雲端科技及智慧終端的普及，已經改變了人與人之間的溝通模式及行為，而ICT技術與健康管理的結合議題，也在全球各地展開相關產品的研發及產業營運模式的探討。

本論文以ICT(資通訊)健康管理產業 - 遠距健康照護運用進行商業模式的探討。文中將帶出相關的議題 : 1. 高齡化趨勢下，各國健康促進及健康老化的政策發展及推動。 2. 資通訊與健康產業的結合與發展。 3. 遠距健康照護產業商業模式的探討。

我們發現雖然遠距健康照護是政府積極依據高齡者需求規劃推動的政策，也符合老人面臨的慢性病需要持續照護的需求，國人接受家中老人居家/社區老化的習慣做法，但推行至今未見普及，一些專家學者歸納問題原因包含 : - 國家制度問題(如勞保醫療制度濫用、退休年金不均等問題、醫療法令限制)。 - 遠距照護觀念未被普遍接受。 - 科技化服務產品的操作便利性。 - 收費及定價的問題，沒有穩定的獲利模式。

所以一些廠商在完成政府相關專案計畫後，發現不如預期及對應的商業模式無法建立，以至於在找不到穩定的獲利模式及長期虧損下選擇了停止開發及服務。但觀察國內的部分廠商仍持續投注於此趨勢產業，我們也看到產業有逐漸邁向穩定及成長的機會，這些徵兆是值得我們關注及探討分析。

研究發現此一產業的特性及發展的過程，看到資通訊遠距健康照護是一個創新的科技系統服務產業，須結合不同異質產業進行分工及整合，與單純提供或是製造資通訊建康管理、量測設備及系統有所差異。我們看到其成功及成長的關鍵除了在資通訊科技功能性的開發及商品化，也需要關注下列的議題，才能形成一個完整的商品架構。如科技與服務整合，企業與社會價值兼顧的創新商業模式思維及規劃。一個合乎趨勢需求的資通訊遠距健康照護商業模式，面對現況推廣所遭遇到的問題，應該包含下列元素。 - 人性化服務 - 以關懷為核心價值的商業模式及持續創新的調整策略。 - 企業價值鏈活動 - 應該加入與社會共享價值的主張及具體的行動。 - 結合政府的健康促進及健康老化的政策。

亦即企業在確認建立有效的短期及長期獲利模式前提下，以整體的思維進行產品服務系統的關鍵資源及流程建立。我們以克雷頓．克里斯汀生Clayton M. Christensen，商業模式再創新(Reinventing your business model)及麥可．波特(Michael E. Porter)創造共享價值（Creating Shared Value）的雙模式來架構一個合於遠距健康照護產業的創新商業模式，並以知名成功的遠距健康照護公司為例，以理論與實際的商業模式探討及進行公司拜訪及專家訪談，結果顯示成功的遠距健康照護業者其商業模式符合我們的主張，也顯示在台灣這是一個前瞻性的健康服務產業，需要有更寬廣全面的思維及眼光，持續創新布局建立合乎顧客價值主張的產品，除了企業的經濟價值的追求外對於社會環境、效益及公益等活動也要兼顧以等待商機及市場成熟的時刻，當然政府的政策仍將是主導整個產業生態鏈的形成及產業發展成功的重要關鍵。

研究建議，一個趨勢產業在各先進國家已經有了成效，老人們在國家的健康政策下享受健康促進及科技化健康照護的服務，而在國內卻陷入發展的窘境，仍處於萌芽的階段，遲遲未見預期的成長。我們認為規劃起先企業或是政府的局部思維是阻礙產業發展的主要障礙，大家看到人口結構的改變帶來的市場，卻沒有成功的推出整體價值主張的商品，面對新的科技產品無法改變及影響國人的健康醫療的習慣，寧可安於有病才送醫，而不願接受遠距健康照護來來的預防醫療的新觀念、新科技。

以老人遠距健康照護為例它影響層面涵蓋個人(被照護者)、家庭、社區的互動及價值共享；政府的醫療資源及健康福利政策；人性關懷與科技產品使用者經驗；異質合作廠商的營運模式及服務平台建立，這是一個複雜的生態系統及營運方式。所以在企業進行更細部的商業模式創新之時，政府與企業更需要有下列的體認，共同努力為國家的健康促進政策及老人醫療資源問題找到一個方向。

就政府政策面¬- 政府應該適時調整國家健康促進的具體主張，架構老人健康老化/活躍老化的環境包括硬體及軟體等規劃及藍圖及與老人健康相關議題的法令調整。讓老人健康產業可以依循，因而建立可以獲利的商業模式。例如長期照護保險的推動、遠距醫療與照護的法令合宜調整等。

就企業發展面 - 認知資通訊科技服務的需求包括異質企業資源整合平台與健康促進的服務。同時要兼顧技術與服務；個人與家庭/社群；企業經濟與社會效益，這是一個全方位的服務體系及共享價值體系。

在政府政策的支持、法令制度的調整配合下，以整體的核心思維架構企業價值鏈活動並與社會效益連結，同時規劃進行的共享價值商業模式，以短期、長期；個人、社會來設計營收的模式，這是現階段本研究的結論與建議主張。

It is evitable that Taiwan is soon approaching an ageing society, with a projected ageing population (65 years or older) accounting for 13.67% of the total population by 2017. Coming with this trend is the market demand for products and services to meet the needs of these relatively wealthy retirees, hence creating a unique niche and business opportunity that must not be overlooked.

To properly address the health and ageing issues, the Government of Taiwan has announced corresponding policies and programs. The industrial, governmental and academic sectors have also been aggressively planning and developing a friendly and effective service platform to enable a sound business environment with high functionality. ICT-assisted remote healthcare services undoubtedly meet this need, therefore sparking a worldwide effort on research and development of innovative products and suitable business models.

This paper is to study the business model of ICT-assisted health care service companies – targeting at ICT-assisted remote healthcare services. Major subjects under the study are:  Review of international policies and plans on healthcare of ageing society  Integration of ICT technology and healthcare service industry  Investigation of business model for remote ICT-assisted healthcare services In this study, it is found that, despite of the governmental effort in promoting remote healthcare services, the program has not been widely practiced yet. Experts have attributed the reasons as follows:  Inadequate national system (abuse of labor medical care system, uneven retirement annuity, restrictions of medical regulations)  Concept of remote healthcare not being widely accepted  Less-than-easy operability of technology-based service products  Unsure profit model resulting from problems of fee collection and pricing

As a result, many companies opted to discontinue their effort in business development and services, after failing to secure a profit model and suffering from a long-term loss. Nevertheless, few companies are still active in this emerging business and there is a sign of business growth at this moment, hence warranting a further study and assessment of a feasible business strategy.

An in-depth research reveals that, ICT-assisted remote healthcare represents an innovative technology-based service, which requires a horizontal split of work and vertical integration among different industries. In addition to the development and commercialization of performance-oriented ICT technologies, there is a need to incorporate other considerations, so as to ensure a complete product framework and a successful business model. In other words, a full integration of technology and service will necessitate the reflection and planning of an innovative business model which takes into account of both entrepreneurial and social values. Such a model should include the following aspects:  Humane services – a care-oriented business model with continual innovation strategy  Entrepreneurial value-chain initiative – value sharing with society and action plans  Measures to match the governmental policy on health promoting for ageing population

That is to say, within the overall guideline of ensuring a short and long-term profitability, an enterprise needs to take an integrated approach towards establishing a key resource and flow system for value-added product services. During this study, an innovative business model for remote healthcare has been developed, based on Clayton M. Christensen’s “Reinventing Your Business Model” and Michael E, Porter’s “Creating Shared Value”, and verified against the case of a successful remote healthcare company. Company visit and expert interviews have been conducted. The results have confirmed our proposed business model for ensuring a successful remote healthcare operation. It also indicates that remote healthcare business is promising, but a comprehensive thinking and approach is a must for this industry. Continual product and service innovation to meet the dynamic needs of the clients has to go hand in hand with the corporate strategy of coping with the change of the social environment, to ensure the corporation’s economic profitability.

This study suggests that, the remote healthcare industry has proven to be successful in advanced countries and the aged population enjoys a technology-enhanced healthcare service. However, the same has not been observed in Taiwan. It is our belief that, the lack of a comprehensive and integrated thinking as well plan on the side of both the industry and government is perhaps the stumbling block to its further growth. While aware of the potential business opportunity, there has no real effort in offering a value-added remote healthcare product and service. The community in general is insensitive to the benefits that technology-based healthcare products bring, particularly with respect preventive medical care. Rather, the ageing population still chooses to visit the clinics and hospitals when in illness.

The remote healthcare for the ageing population triggers an interaction and value-sharing among the individual (aged people), family and community; government’s medical care resources, health and welfare policy; humane consideration and experience of technology-enhanced products; business model of cooperative industries and service platform. This indeed reflects a complex eco-system and business model. It is for this very reason that the government as well as the industry need to recognize the complexity of the involved issues, and work together to find a solution to resolve the hidden policy and resources problems.

On the matter of policy, the government is recommended to make timely adjustments to the health promotion measures, set up necessary software and hardware systems to suitably care and relive the aged people, and revamp the relevant acts and regulations to facilitate the operation and growth of the healthcare industry for the aged population. Examples include: promotion and implementation of long-term care insurance, reasonable adjustment of remote medical care acts and regulations.

As for the healthcare industry, it is highly suggested that a full spectrum of aspects must be considered and integrated, to consolidate the resources of different industries and service sectors. This full service and value sharing industry must weigh in the following business elements at the same level, including: technologies and services; individual as well as family and community; business profit and social benefits.

This study concludes that, with the appropriate governmental support and regulatory adjustments, a suitable strategy for ICT-assisted remote healthcare needs to be built upon a core corporate value chain tied to social benefits, so as to plan a value-sharing business model, and design a short and long-term revenue-profit model considering the factors of individuals as well as the society