目前台灣中醫以門診為主，雖有部分醫院經營住院部門，但由於現階段全民健保尚未將「中醫住院」納入為給付範圍，導致中醫住院的病患必須全部自費，所以利用率偏低，因此中醫的主要業務仍在診所部分。1995年至2010年的統計數據發現，中醫診所有急遽增加的趨勢，加上中醫師人口成長幅度過快及中藥材成本上升，使中醫診所面臨激烈競爭，而如何有效提升醫療服務品質與病患回診意願，將是診所經營者當務之急。 　　本研究參考蔡文正等人(2008）運用PZB(Parasuraman, Zeithaml and Berry）SVERQUAL量表所建立之中醫醫療服務品質評估指標，衡量模式的五個構面，分別是有形性、可靠性、回應性、保證性及關懷性，並根據回診意願之相關文獻，發展出病患回診意願之評估指標，藉由問卷調查，以新北市五家中醫診所病患為研究對象，探討病患對於中醫診所提供之醫療服務品質的重視情形、實際接受服務後的滿度程度及回診意願的影響。 　　研究結果顯示中醫診所病患對於醫療服務品質的實際感受較本身所期望之服務有落差，不同特性之病患對於醫療服務品質的重視程度與滿意程度、回診意願也有差異情形；由相關分析與迴歸分析得知，醫療服務品質重視程度和滿意程度，與回診意願皆有顯著的正相關存在，且以醫療服務品質的「回應性」、「保證性」及「關懷性」三個層面的滿意程度，對「回診意願」有較高預測力。故未來中醫診所針對回診意願之提升，應以此為主要策略目標；同時，對於滿意程度較高之指標應強化、保持，在增進病患回診意願上必有所助益，俾使民眾擁有更優質之醫療環境。

本論文的研究目的，乃在瞭解台灣地區私立醫療機構成本控制制度的現況，並探討影 響成本控制制度良窳的因素，俾對私立醫療機構的成本控制制度提出改進的建議。 本論文的研究方法，包括初級資料及次級資料的研究。研究程序包括：（１）廣泛的 文獻探討，（２）利用函證搜集相關的資料，（３）評估、分析與解釋所蒐集的資料 ，（４）提出改進的建議。 本論文共一冊約六萬餘言，全文分為七章，第一章：緒論。第二章：醫療機構的成本 控制制度，包括：（１）成本控制制度的概念。（２）醫療機構的成本控制制度。第 三章影響醫療機構成本控制制度的現況。第六章：影響台灣地區私立醫療機構成本控 制制度的因素。第七章：結論與建議。

全民健保自開辦以來，財務一直存在入不敷出之隱憂，醫療院所頻頻呼籲健保的給付不足，將造成經營困難。除此之外，醫師人口逐年增長、診所成本入不敷出、人口老化迅速及新醫療設備之引進及各政策之影響下，本研究想瞭解在競爭及不確定的環境中，診所應如何以創新經營。本研究導入資料採礦之觀點，將商業智慧用於眼科診所之案例，利用忠誠度分析、流失度分析、獲利貢獻度分析、就診時段分析，想瞭解診所客戶之特性並且針對其習性及特點，並加上SWOT分析，清楚瞭解診所內部之優缺點及外部的機會與威脅，作好準備以謀取事業的永續發展。忠誠度分析之結果發現，其特點為家庭來診人數最多，性別比例較其他集群平均，案類分佈則以一般案類為主，年齡層為22歲以下及35歲以上居多；而在獲利貢獻度中，高利潤收入之地區分佈為竹北市、新竹市明湖路、福德街等；在流失度分析當中，研究發現客戶群在22歲以下，案類為一般案類，且兩人看診家庭的流失比例最高；最後就診時段分析當中，發現所有病例之地區時段、看診日分析看診人數除星期四外，皆以早上時段為最多。資料採礦是很好的輔助工具，將商業智慧應用於診所之經營上，可依照不同的分析集群搭配不同的行銷策略，增加競爭力，規畫創新之營運模式，以追求更好的發展。 / Since its start, expenditure exceeding income has always been a hidden concern in the finance of the National Health Insurance (NHI). Medical clinics have repeatedly said insufficient payment from the NHI will result in difficulty in their management. Moreover, other factors are affecting the clinics, namely, the growing number of doctors statewide, the income shortage of running a clinic, the rapidly aging population, the introduction of new medical equipment, and the various new policies. This paper intends to explore some innovative management plans for the clinics in a competitive and uncertain environment. Business intelligence is applied in the case study of an eye clinic. The analysis of client the degree of loyalty, run off, profit contribution, and visiting time help understand client habits and characteristics. A SWOT analysis further helps the clinic clearly understand its own strength and weakness, and the opportunities and threats from outside. Thus it can better prepare itself for a long term business. The analysis of client the degree of loyalty shows the following: most of the clients are family members; there is an even male/female ratio while in other categories it is not so; most medical cases are general cases; most of the clients aged under 22 or above 35. The analysis of the degree of profit contribution reveals that the districts related to higher profit are Zhubei City, and Minghu Road and Fude Road of Hsinchu City. In the analysis of The degree of run offs, it is found that most of them are under 22, most medical cases are general cases, and most of the clients are two people from a same family. Lastly, in terms of visiting time, analysis shows that most of the clients, regardless of their residential areas, visit in the morning except on Thursday. Business intelligence is an helpful tool. According to the analysis a clinic can match different client groups with different marketing policies, enhance it competitive edge, plan for an innovative management model, and pursue a better development.

摘 要 醫療品質日趨重視，但是，對於醫療品質的測量方法卻無一定論。以往有關於醫療品質的研究均是從客觀角度著手，從主觀面著手的研究卻都沒有屬於量化的研究。再加上，過去醫療品質的相關研究均是以大型醫院為研究對象，缺少基層診所的樣本。然而，大型醫院的性質與規模與基層診所相差甚遠。因此，本研究以基層診所患者為樣本，發展主觀面的醫療品質測量工具，並論證主觀面醫療品質的重要性。 本研究以變異數分析來檢測病患主觀上對於醫師醫療過程滿意度是否有差異？研究結果顯示，病患個人基本特徵上的差異是會影響到病患主觀上對醫師醫療過程的滿意度。由此可知，病患是有差異性的個體，病患主觀上對於醫療品質的感受度會因不同的個人特質而有所差異。測量醫療品質時若只測量客觀層面而忽略主觀層面是無法測量出醫療品質的全貌。 為更深入分析基層診所病患與醫師的互動，透過因素分析發現了四個因素與基層診所的醫病互動有相關，分別是：醫師看診表現、醫療專業與同理心、病況問與答、仔細與細心。並發現在基層診所的醫病互動中，病患感受特別深的是醫師的看診表現而非醫師的醫療專業。而透過變異數分析也發現病患個人基本特徵在不同因素上的滿意度也是有所差異，更是印證病患主觀層面滿意度的重要性。 本研究建議後續研究者能透過施測與修改來確定研究問卷的效度與信度，並能將這份問卷發展下去成為一套適合台灣基層診所病患主觀面醫療品質測量問卷。 關鍵字：病患滿意度、醫病互動、主觀滿意度、醫病關係、基層診所

The Enriching Dermatology and Aesthetics Clinic (EDAC), offering both general dermatology outpatient service in participation with National Health Insurance (NHI) and self-paid medical cosmetology service in Shulin District，New Taipei City is about to celebrate its 2-year-old birthday. The NHI business is getting on the track with stable outpatient visits; however the revenues of the cosmetology do not live up to the expectations. The business plan tries to review the company records, strategies, the competitors and market trends to propose practicable action plans to boost the revenues of the cosmetic service, while maintaining the quality and growth of NHI business.

顧客關係管理(CRM)在國內外已有不少應用實例，但在醫療服務業鮮少被研究過，本研究嚐試將資料採礦的三大核心技術：資料庫管理、Domain知識與資料採礦技術三者予以整合，針對一個獨立經營主體（聯合診所），從行銷策略制定、營運策略描述與執行到經由資料採礦得到具體結果，重新檢討行銷策略之STP定位與導引未來經營策略，並提出一對一行銷的診所病患管理架構。 本研究以一個新成立的診所，取其開業之初(89年12月)至92年1月底止，所累積九千三百多位患者的5萬多筆門診就醫記錄進行資料採礦分析希望研究以下幾個問題： 1.哪些病患帶來最大利潤?為甚麼?哪些患者容易流失?為甚麼? 2.哪些交叉服務對何種患者適合?哪些服務對增加慢性病患者有幫助?糖尿病患者接受視網膜檢查的可能原因為何?婦產科門診所增加的病患,是否會同時接受診所內其他科的服務?是否應該繼續擴大其他專科? 3.診所病患主要的居住地區如何描述？ 研究結果顯示較高獲利組與高醫療費用,高忠誠度,高就診次數,高藥費比率,高慢性病費用比率有關，以疾病別來看，集中在慢性疾病患者身上。顯然經營策略上的意涵是如何爭取慢性病人的高度滿意及信賴度，贏得高忠程度，患者願意將診所視做健康上的守門人(Gate Keeper)，而從地區別分析中也發現一些，診所服務之涵蓋範圍，可以區分為距離效益、慢性病患者口碑效應與轉移效益。慢性病患者之分群可以分成黃金老主顧、會忘記看病的老主顧、快流失的老主顧、高穩定低忠誠度高獲利新客戶、不常來但還會來的一般客戶、已流失的舊客戶、已流失的中期客戶及流失已久的舊客戶，至於非慢性病患則不需太複雜的分群，本研究建議將非慢性病患者依健保卡卡序計算就醫忠誠度區分。慢性病患群流失的原因與無法提供完整治療，疾病症狀不明顯或與民眾對治療效益的看法改變有關（如更年期）有關。 就病人區隔分析及交叉服務的相關分析都可以發現，以慢性疾病群為中心，針對不同疾病群發展網路治療團隊，應該是未來診所擴張時需要遵循的最重要策略原則；另外健保案件類別的交叉分析，也發現增加預防保健服務可以增加慢性病人的案件，診所需要將成人健康檢查業務當作策略性業務，加強重視並提升品質。 本研究針對描述患者求醫行為過程所發展出對個人主要疾病診斷碼的歸戶處理、RFM相關指標方式、健保卡卡序計算忠誠度及邊際利潤的計算方式對於類似研究應該有其參考價值。至於本研究所提出的診所病患群分群架構，則有待進一步評估其達到CRM顧客最佳化的效果。 / At present, there are much of researches of Customer Relationship Management ( CRM ) and data mining in Taiwan. There is little research in medical service. Our research tried to integrate the three domains knowledge, DBA, domain knowledge of medical service and data mining techniques. This is a case study type research. The CRM Strategy Planning for Outpatient in Kai-Nan Group Practice Clinic by Data Mining on National Health Insurance Dataset. This research included 9300 cases of Kai-Nan Clinic, with nearly 50,000 records of OPD records from Dec, 2000 to Jan, 2003. Our research questions include as followings: 1、How to segment the outpatient, which segment is the most profitable? Which segment is loosing? Why? 2、Which cross service is necessary for what kinds of patients? What kinds of services will be benefit for recruiting chronic patient? What is the reason for the diabetes patient will receive funds examination in this clinic? Are the patients of GYN/OBS will also to be patients of other specialty? Is it necessary to include other specialty in this clinic? 3. Where is the most profitable patient in nearby area? Our study revealed that the most profitable patients is characterized by high medical cost, high loyalty to this clinic, high visit frequencies, high portion of medication fee and high portion of fee for chronic disease. Most of the profitable patients are suffered with chronic diseases. This implies that how to satisfy chronic patient with high satisfaction and earn their trust to be health gate keeper for this patient is very import issue for a clinic. From the results of area analysis for these chronic patients, we concluded the three effects for different areas, such as near-distant effect, public praise and addict effect for original doctors. The segments of chronic patients include golden regular customer、forgetful regular customer、loosing old customer、regular but lower loyalty profitable new customer、irregular general customer、loosed old customer、loosed past customer and loosed old customer. Regarding the segmentation of outpatients of acute illness, we recommended simplify classification according to loyalty that was calculated from the sequence of national health insurance card used in Taiwan. The chronic patients loosed in the clinic was due to lack of comprehensive treatment options, non obvious symptoms or the fears of treatment side effects announced from public media，such as hormone replacement therapy for post menopausal syndrome. We conclude that multidisciplinary team for comprehensive disease management is very important for clinics as our previous success experiences on diabetes patients. Our clinic should expand teams with out bond member according to the needs of our profiles of chronic patients. From association mining, periodic health examinations increase the base of chronic patients. It is strategic important to enhance the staffs and facility for handling periodic health examinations. Our research will also contribute to the following research issues , such as how to describe patients behaviors, how to extract the dominant diagnosis from patients health insurance records, modified RFM dimensions indexes、loyalty based on sequences of health insurance card in Taiwan and the model of calculation of marginal revenue for clinics. As regarding the efficacy of the patients’ segmentation model deserved further study.

對企業競爭力問題的研究一直是一個熱門的話題，但是對牙醫連鎖企業競爭力問題的研究文獻還是很少。究其原因如下：牙醫連鎖業是一個專門性很強的行業，其服務過程、市場特徵和產品特性有許多不同於一般性製造業和商業的地方。許多研究競爭力問題的文獻大多熱衷於一些重要的產業或帶共同性多一些的產業的企業競爭力問題的研究。 本文以連鎖企業管理、核心競爭力理論、價值鏈理論為基本的分析基礎，對牙醫連鎖企業的經營環境和經營現狀作深入研究，探討個案牙醫連鎖企業的競爭力狀況、構成要素、影響因素；對牙醫連鎖企業的價值鏈做深入分析，提出建立基於價值鏈的牙醫連鎖企業的核心競爭力體系的基本觀念和提升其核心競爭力的途徑和方法。