論文摘要 非營利組織領域表面上溫和平靜，不像身處各種產業市場的營利事業，面臨快速的產品生命週期變化及激烈的市場同業競爭。但實際上，非營利組織要能在現代資訊爆炸的社會中存活壯大，必須克服重重發展挑戰，才能掌握社會大眾的認同及支持。上述發展挑戰不僅適用於既有的非營利組織，對於新成立的組織影響更大。 本研究以一家國際性醫療非營利組織的台灣結盟組織作為個案研究的主軸，檢視其目前營運的模式、策略，並對其目前的經營現況作一全面的診斷，試圖了解個案組織目前所面臨的問題以及整個公益類別領域未來可能的發展趨勢。研究架構，基本上採用Aaker的理論架構來進行內外在分析，而整個策略規劃的過程則依據Glueck所提出之策略規劃架構進行。 研究發現，非營利組織「公益議題替代性極為強烈」，組織本身必須在整體議題上面建立足可與其他公益議題相提並論的重要性及迫切性，成為「類別殺手」，才能在消費者記憶領域及後續贊助決策中與其他公益議題享有一席之地。而面對景氣不佳、企業營運重心外移等總體環境問題，非營利組織-特別是國際非營利組織，更可藉由發展國際合作網路，嘗試開發政府援外資源以及台商企業在各國市場的公益行銷或企業形象資源，創造企業、政府、非營利組織、及當地社會多贏的局面。 本研究認為，個案組織目前在根本策略上，應採「成長」策略，短中期採市場擴張策略，往政府、企業、及個人捐助者等重點市場發展；中期則採產品擴張策略，往公衛行銷計畫、企業社會責任管理倡導、企業夥伴資源整合、社區眼睛健康永續管理計畫發展；長期採取相關多角化策略，從事社區經濟發展與除貧計畫等。 本研究建議個案組織，要加強議題重要性及迫切性的行銷，一方面可進行更廣更深的議題環境及社會效益分析，更可藉由意見領袖背書或國際案例故事帶動議題情感連結，或以本土服務案例來整合全球相關方案，引發社會大眾共鳴；當然，更重要的是，要做好品牌管理作業，成為社會大眾心目當中醫療公益類別的首要選擇。

隨著科技的發展，帶動全球化潮流，「病人無國界」的趨勢也因而形成。醫療資訊普及流通，民眾可以在此基礎上，尋求最能滿足自我需求的醫療服務，於是出現了跨越國界的醫療型態。相較於歐美國家高昂的醫療費用與冗長的就醫等候時間，亞洲國家擁有健全之醫療服務與品質，且能享有較低廉之醫療費用，促使著歐美國家民眾紛紛前往亞洲國家就醫。其次，隨著M型化社會型態在各國發酵，經濟能力較高者，對於跨國尋求高品質、高技術醫療服務的需求就越多，加上科技發達，人類平均壽命逐漸延長，形成高齡化的社會，帶來了全球醫藥保健與健康照護產業龐大之商機。國際醫療因而成為近年來炙手可熱之新興產業，帶動龐大經濟產值，進而促使許多國家開始重視此面向，紛紛開始推動各項政策，爭取發展國際醫療之契機。台灣正式推動國際醫療發展計畫至今已經九年多，國內許多公、私立醫療院所都加入此推動行列，但成效如何，以及公私立醫院在推行國際醫療上，所建立的經營模式是否相同等，都是本研究的重點。 本研究以個案分析法，運用Mark W. Johnson, Clayton M. Christensen, 及Henning Kagermann的商業模式再創新之四大構面「顧客價值主張」、「利潤公式」、「關鍵資源」、「關鍵流程」，探討公、私立醫院發展國際醫療服務之經營模式，並分析公、私立醫院經營國際醫療的差異處、不足之處以及彼此可學習之處，藉此提供兩者未來操作國際醫療策略之建議。 研究發現，私立醫院在建構國際醫療商業模式上相對公立醫院來的完整，主要原因為，公立醫院仍受限於傳統體制約束，無法建立符合國際醫療之流程，但公立醫院因為歷史悠久，因此有品牌優勢，只是此優勢很可能會隨著競爭對手的強力曝光而慢慢消失。相反的，私立醫院在操作國際醫療上較有彈性，但仍必須積極推廣自有品牌，以強化自身競爭優勢。 / With the rise of globalization, the advancement of technology and breakthrough in healthcare, people nowadays seek the best medical care in all parts of the world. People could search and choose to get the healthcare they hope to receive without borders. In western countries where medical care is expensive and inefficient, more and more people from these nations are flocking to Asian countries like Taiwan to receive a more complete and cost-efficient health care. On the other hand, upper class people in an M society could have the privilege to seek the best medical care in countries where healthcare is more advanced. Therefore, International healthcare service has been one of the most important strategies for hospitals in countries like Taiwan. Most private and public organizations in the medical field have put their efforts to integrate the most reliable sources to join this trend. The purpose of this study is to explore how public and private hospitals in Taiwan set up their business models in regards to international healthcare, and verify if their business models are feasible. This study implemented case study methods and applied “customer value proposition”, “profit formula”, ”key resources”, and “key processes ”, four dimensions of successful business model proposed by Mark W. Johnson, Clayton M. Christensen and Henning Kagermann to discuss the different factors for public hospital and private hospital in international healthcare. This study expects to discover the key successful factors and provide suggestions to each of them. The results of this study show that public hospitals regarded as non-profit organizations are less flexible because of the limitation on traditional regulations, thus it is difficult to set up a more complete and internationalized business model. On the other hand, private hospitals are more flexible. In order to strengthen their competitive advantage, these private organizations must promote their own brand actively to achieve a competitive advantage in this globalized trend.

台灣發展醫療旅遊／國際醫療服務一直備受爭議。本研究主要以意見場域為基礎，深度訪談與次級資料的論述分析為方法，探看台灣發展醫療旅遊的過程中，相關行動者以何種論述策略正當化自身持具之立場、其中又反映了何種為行動者視為當然之預設；進而找尋各方溝通之可能性。 依照「與國際醫療服務有關的政府主要推動計畫時程」和「論辯的主要議題」兩者，本研究將所探看的發展時間分為三時期，分別為：（1）關於醫療服務國際化是否應該發展以及如何發展的討論；（2）行政院核定以公司化、專區化作為主要發展方向所引發的論辯；（3）國際醫療納入自由經濟示範區之後的實體專區發展模式所引發的論述競逐；進而歸納並分析共23種論述策略。進一步從存續的策略和消失的策略提出以下幾點命題：存續的策略彰顯出行動者在意見場域中爭奪正統地位的原則，分有「存在非營利本質的醫療」和「全民照護優先」兩者；消失的策略則意味著從意見推進至俗見的面向，分有「失敗案例不具評判國際醫療成效之效力」及「配套一次到位的不可能及其必要性」。 綜觀整體發展過程發現，國際醫療服務似仍深陷論述的泥淖中：在蘊含著各式各樣論述策略的整體發展過程中，各方雖有「存在非營利本質的醫療」和「全民照護優先」兩個共同的論辯原則，但仍存在不可達致共識的鴻溝；其中，反對發展者論述的「策略性」似不如支持發展者要多元。這樣的態勢究竟將走向收斂或發散，值得持續觀察；然而，持著「有自己的想法並尊重他人想法，同時適度修正自己的想法」此心態，當是在這「亂中有序」的態勢中達致溝通的有效前提。 / The development of medical tourism in Taiwan has been a controversial issue in recent years. Based on the concept of “field of opinion,” the thesis uses discourse analysis and interview as methods to analyze: (1) how the related actors justify themselves with diverse discourse strategies; (2) the presumptions which are underlying those justifications and taken for granted by the actors; (3) the possibility for those actors with different opinions to reach the stage of consensus.The thesis follows two principles to analyze the collected data. One is the time schedule of the related government projects; the other is the main foci in the whole development process. With the two principles, the whole development process is split into three periods: (1) the debate upon whether medical tourism should be promoted and how to promote it; (2) the debate upon the possibility of organizing hospitals in corporate form within a specific bounded area; (3) the debate upon if it is right to set up international medical centers in the “free economic pilot zones.” The thesis founds 23 discourse strategies that actors used to justify themselves in the whole development process. Furthermore, the author argues that the subsisting strategies represent the principles actors hold to compete for the orthodoxy in the field of opinion. In the thesis, the principles refer to “medical affairs as nonprofit” and “citizen first.” The disappearance of strategies then represents the doxa which used to be opinions. In this regard, the thesis founds that those failing government projects become unrelated to the effectiveness of medical tourism which is being promoted. While everyone knows that to have all supporting projects settled is impossible, forming the supporting projects once and for all is still necessary. All in all, the author argues that although “medical affairs as nonprofit” and “citizen first” are the two common principles between the supporters of medical tourism and their counterpart, to reach the stage of consensus, there is still a long way to go; the supporters seem to have more diverse strategies to confront their counterpart. After all, respecting each other and modifying one’s own opinion in progress might be the effective presumption to get settled in such a full-of-chaos-but-ordered condition.