透過網際網路的發展以及跨領域與旅遊觀光產業的串聯，健康管理與醫療機構的經營模式已有重大的變革，機構的服務對象及客戶病患來源，不再受到距離與地域的限制; 醫療過程前-中-後的關鍵步驟，例如手術前的資料收集、客戶諮詢，亦或是治療後的追蹤、關懷，都能透過「醫療觀光網路平台」的運營，來提昇客戶滿意度及達成永續經營的遠景。醫療觀光網路平台要能成功發展，機構必需具備「關鍵成功因素」，本研究經由文獻回顧，了解醫療觀光之產業特色及其網路平台之需求後，採取個案研究法，分析「雄獅旅遊網」的歷史發展、組織沿革、經營策略、全球佈局等，將個案發展過程中的重大關鍵決策，與本研究提出的八大構面以及其內含的關鍵成功因素，進行比對與分析。 本研究的三大目的為: (一) 分析「醫療觀光產業」之特色及其對「健康醫療網路平台」之需求與應用; (二) 找出「醫療觀光網路平台」的關鍵成功因素; (三) 建構「醫療觀光網路平台」構面模型。 研究結果發現， 「醫療觀光網路平台」的「關鍵成功因素」構面模型包括: (一)「品牌行銷構面」;(二)「信任溝通構面」; (三)「專業品質構面」; (四)「感動體驗構面」; (五)「資訊科技構面」; (六)「資源整合構面」; (七)「人才管理溝面」; (八)「永續維繫構面」。 本研究提出的構面模型，可提供醫療觀光網路平台的經營者，做為企業發展重大決策的參考依據; 醫療觀光生態圈的所有成員，應本研究提出的關鍵成功因素，讓各構面之間相互整合，並加強生態圈成員之間的緊密合作。如此一來，平台就能實際幫助到目標客戶族群，讓台灣醫療觀光的發展更上一層樓。

追求美麗是人的天性，隨著生活水平與國民經濟之提升，以及醫療科技之進步與發展，針對外觀容貌與身體形態來進行美化與改善的醫學美容，已成為社會上普遍之現象。醫學美容具有醫學與美容之雙重性質，透過手術、藥物、醫療器材等醫學知識與技術之運用，具有創傷性與侵入性，存在一定風險，加上美容整形之效果往往涉及個人主觀之認知，因此，當發生併發症或期待與結果有落差時，往往衍生出許多糾紛。醫學美容之醫療糾紛，其民事法律依據一般為侵權行為責任，亦可依契約性質，請求債務不履行之責任。此外，尚可能發生醫療廣告或產品責任等相關問題。透過本論文之探討並提出建議以供處理相關案件之實務及醫療從業人員參考。 本論文共分七章，第一章為緒論，說明本論文研究之動機、目的、範圍與方法。第二章為醫學美容之性質，針對醫療行為之定義，分類與範圍，進行整理分析，並探討醫學美容之定義、範圍、執行資格。此外，就醫學美容與一般美容及一般醫療行為之異同作出區別，及說明常見醫學美容糾紛之原因。第三章為醫學美容契約之契約責任，針對醫學美容之承攬性質、給付義務、瑕疵擔保責任、債務不履行、免責約款等問題探討其要件與效力。第四章為醫學美容醫療之侵權行為責任，由於醫療糾紛多以侵權行為處理，此章就告知說明義務與醫療行為上之注意義務、舉證責任，與契約責任之競合等進行論述。第五章就現行法院實務判決作整理與分析比較。主要分為注意義務違反、說明義務違反、不滿意之結果等三個類型。第六章為其他責任問題，就消費者保護法之適用問題，以及衍生之醫療廣告與產品責任等相關責任問題，進行探討。第七章為結論與建議，綜合上述各章之研析，對醫學美容之相關民事法律責任及醫學美容糾紛之預防，提出相關建議與展望。期盼懇切對話溝通，客觀釐清責任歸屬，圓滿解決爭端，達成和諧互信之理想境界。

全球醫學美容的蓬勃發展，醫療院所在提供醫學美容服務同時，除了專業的醫療技術之外，也向消費者推薦這些可以幫助術後保養的醫學美容保養品。而這些經由臨床測試及專業醫師證實對於皮膚健康有療效的醫學美容保養品，既有科學的證實加上醫師推薦，形成一定的公信力，和一般市面上的美容商品形成區隔，進而讓這些起手術後搭配塗抹的醫學美容產品，也另闢形成一個全新的商機。 本研究針對醫學美容保養品產業以先進者優勢的相關研究進行探討，而過去的醫學美容文獻比較注重於由消費者端出發的議題研究，對於醫美品牌廠商進入產業的經營卻付之闕如。有鑑於此，本研究透過個案研究的方法，以國內醫美保養品品牌為例進行先進者優勢之探討，試圖找出欲成功達先進者優勢廠商需具備的能力和面向。 根據本研究顯示出台灣醫學美容保養品廠商進入市場具有先進者優勢，本研將究對於各品牌採用不同通路（醫療、開架式、網路）、不同品牌定位（高、中、平價）的醫學美容品牌，以其先進者廠商佔據不同的市場。各品牌廠商的優勢組合及養成及差異化形成：品牌廠商一方面教育消費者，並建立起「醫學美容保養品」的新概念，將專業度提升和傳統的保養進行區隔；另一方面建立起公司自身優勢，在此產業進入的廠商的優勢來源有：佔有技術領先、關鍵要素佔領和將顧客不確定性的消除，隨著廠商本身不同的資源，選擇專屬自身的行銷組合經營，並與供應商、通路商和終端的顧客建立關係。將產品多元化和採多品牌策略，滿足不同消費族群，而達到產能擴增、成本減低和增加其市佔率，藉此不斷擴增公司資源，進行更多的產品創新、技術精進和品牌行銷，卻也成為後進者進入市場的天然屏障，得以維持自身的優勢。 / Medical cosmetology is now growing rapidly around the whole world. Clinics, which perform cosmetic surgery, provide not only professional medical services, but also promote those cosmeceutical products which can help quick recovery from surgery. These cosmeceutical products, which have the approval from doctors and passed clinical trial, build a strong barrier for its competitor and create a new business opportunity. This research tries to study the First-Mover Advantage of the cosmeceutical industry. The old studies of cosmetic surgery focus more on customer driven issues. There are not many researches about business running for cosmeceutical brand. Therefore, our research study the First-Mover Advantage of cosmeceutical industry in Taiwan by case study methodology and try to find what are the necessary requirements for the First-Mover company. According to our research, cosmeceutical companies have the fist-mover advantage in Taiwan market. In this study, for each cosmeceutical brand have different channel (medical, open-frame , network), different brand positioning (high, middle, parity), with its advanced to occupy a different market. Each brand has their advantages of combination, and develop the differentiation. The cosmeceutical surgery brand companies educate its customer about the new concept of medical skincare product and build up its advantages. The advantages of these companies are: technology leadership, key factor occupation, customer uncertainty elimination. According to different resources of each company, the market and business strategy should be properly managed. The first mover companies have to build up the relationship with its suppliers, channels and end users. Use product diversification and multiple-brand strategy can satisfy various customer groups, increase production capacity, reduce costs and raise the market share. Based on the above strategies, the first mover companies can build up a strong barrier which the followers cannot easily passed, by product innovation, technology improvement, and branding.

本研究試圖從美麗商機的角度切入，討論美麗消費產業的經營者如何提供服務與產品以及美麗消費市場的消費顧客對於此類消費的風險感知程度與消費經驗。研究討論服務品質、知覺風險、顧客滿意度、顧客忠誠度之於本研究的內涵。研究結果發現，醫學美容診所之服務品質、顧客知覺風險對顧客滿意度、顧客忠誠度具有顯著相關；醫學美容診所之服務品質對顧客知覺風險具有顯著負向相關；顧客滿意度對顧客忠誠度具有顯著正向相關；人口統計變項對於服務品質、知覺風險、顧客滿意度、顧客忠誠度具有部分的顯著差異性和影響。研究貢獻發現，微侵入式美容療程-過程導向-服務品質策略；整形美容手術療程-結果導向-口碑傳播策略；醫學美容之於上癮的消費行為。

民國93年4月醫療法修正通過，第82條第2項明文規定：「醫療機構及其醫事人員因執行業務致生損害於病人，以故意或過失為限，負損害賠償責任。」本條之立法意旨係為避免一般必要性醫療若採無過失責任，則會造成防禦性醫療之產生，誠非病患與社會之益。雖修法後認定醫療行為不適用無過失責任規定，但醫療行為是否適用消保法其他規定，則未明文。然，新興醫療型態之美容醫學出現，人們不再單純為了治癒疾病進而追求外觀美貌，破除了一般必要性醫療之特性，此種「非治療性」且「非必要性」醫療的美容醫學服務，缺乏公益性且具消費營利特性，本文認為法律適用應與一般必要性醫療區別。又，我國消費者保護法未對服務設有定義性之文字，故本文加以分析美容醫學適用消費者保護法之理由。 研究方法上係以文獻分析法、美容醫學相關判決書內容分析法、美容醫學使用者之深度訪談法、筆者實際訪查美容醫學診所之參與觀察法，藉此推論出美容醫學之特性加以定性，亦從中了解美容醫學產業真實狀況以提出法律適用上之疑義。 管見認為我國應加強於美容醫學處置分類及美容醫學作業方面的能力要求、針對美容醫學廣告管制、美容醫學手術作業標準與美容醫學道德規範之建立。另，本文建議醫療法第82條第2項修法增訂但書：「但非以治療疾病目的之醫療行為，不在此限。」此種修法方式，則區分一般必要性醫療行為與非必要醫療行為，一則保護美容醫學消費者的權益，二則可據其反面解釋，更進一步確認「一般必要性醫療行為」適用過失責任之立法意旨。 / In 2014 April, Medical Care Act amend Article 82 section 2 “Medical care institutions and their medical personnel who harm patients in the execution of practice, whether deliberate or by accident, shall be responsible for compensation.” The purpose of this article is to avoid “Defensive Medicine” happen when the essential medical procedures apply to the no-fault liability, because Defensive Medicine won’t benefit the patients and the whole society. As a result, medical practice does not apply to strict liability after amending Medical Care Act. However, it doesn’t show medical practice is applicable Consumer Protection Law or not. Nowadays, people are no longer only to cure disease but to pursue the appearance of beauty. Therefore, new type of medical treatments appears - Aesthetic Medicine. This kind of medical treatment breaks down the traits of the essential medical procedures, such as "non-therapeutic" and "non-essential". Aesthetic Medicine which is losing sight of public welfare is actually a business guided by market structures aimed primarily at material gain and profit. Therefore, this study discusses the difference between Aesthetic Medicine and Medical Necessity, and why they should have the different applications of law. In Taiwan, Consumer Protection Law doesn’t define “the service”, so this study analyzed the reasons why Aesthetic Medicine should include in “the service” that should apply to Consumer Protection Law. The method of this study were Documentary Analysis, Content Analysis of the judgments relate to the Aesthetic Medicine, in-depth interview of the Aesthetic Medicine users, Participant Observation of the Aesthetic Medicine clinics, infer a conclusion from the fact that can realize the traits of the Aesthetic Medicine and question the way Aesthetic Medicine apply to the law. The results of this study would provide useful information in drawing related regulations, policies and management strategies. Key words: Cosmetic medicine, consumer protection laws, the non-necessity of medical care, medical cosmetic, medical disputes.

本研究選取國內七間不同層級的公私立醫院，藉由與院方相關決策人員的深度訪談，以個案研究方法，探討各級醫院對於美容雷射儀器與高階影像醫療儀器之採購決策行為，研究中設定「首次採購新型儀器」與「後續購買改良型儀器」的兩種決策情境，以採購意願、採用規格與採用速度等三大決策面向，分析歸納各級醫院對於高階決策的決策行為與考量因素之異同。 本研究結果發現，醫院權屬與層級及採購儀器本身屬性均會影響決策的採購意願、採用速度及採用規格。醫學中心基於學術研究之需，首次購買新型儀器時，偏好採購儀器創新程度高的機種，且其採用速度較地區醫院快。反觀地區醫院較不會追逐儀器的新穎度，對於「儀器是否符合需求及性價比」的重視程度較「儀器先進與否」來得高，不過當地區醫院鎖定特定醫療項目作為策略目標時，會集中資源採購最先進的儀器，並弱化非核心醫療項目之設備的採購意願。 就各層級醫院採購決策的考量因素而言，儀器預期的財務性效益大多是首要考量，私立醫院較公立醫院更注重之，地區醫院則較醫學中心在意儀器的性價比。此外，貴重儀器之醫療必要性的高低亦造成不同層級醫院的決策差異，儀器本身的技術含量與技術創新速度也可能影響醫院採購的意願。 / There are two purposes of this research. The first purpose is to explore how the ownership of hospitals and the features of devices impact on medical procurement decisions. The second purpose is to investigate the factors affecting innovation adoption of medical devices. Based on the case studies of procurement decision experiences made by seven selected hospitals and medical centers in Taiwan, the study focuses on analyzing the willingness of adoption, adoption time, and the favorable standards in procurement decision of aesthetic devices and medical imaging devices. The findings and conclusions drawn from the study show that the academic level and strategy objective of a hospital are associated with the willingness and adoption time of innovation. Academic medical centers are likely to adopt the innovative device earlier for researching purpose, whereas small-to-middle-sized hospitals would be early adopters of innovative products for strategic purpose. In addition, the features of devices also have substantial impacts upon innovative device adoption. Academic medical centers will be early adopters of the medical devices with significant medical necessity. The degree of technology involved and the length of product life cycle of medical devices will affect the medical procurement decision as well. Besides, the priority of distinct factors affecting medical procurement decisions varies from case to case. However, generally speaking, economic benefit will be the most important concern of both private and public hospitals.

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.