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파괴적 혁신과 의료의 미래(2011 5-19)
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파괴적 혁신과 의료의 미래(2011 5-19)

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2011년 5월 19일, 강북삼성병원 당뇨전문센터에서 강연한 "파괴적 혁신과 의료의 미래" 발표자료.

2011년 5월 19일, 강북삼성병원 당뇨전문센터에서 강연한 "파괴적 혁신과 의료의 미래" 발표자료.

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  • Challenge #1 coordination in an increasingly fragmented system: the critical role of primary care, medical home, or a new type of information manager; information collection, storage, and processing often becomes centralized in response to decentralization of services (IBM) Challenge #2 promoting coordinated, systemic change: the role of integrated health care systems, large employers, and the government; who can orchestrate and introduce DI?
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    • 1. 파괴적 혁신과 의료의 미래 Disruptive Innovation and the Future of Healthcare May 19th, 2011 배성윤 PhD, MPH, MBA 인제대학교 보건대학원 및 경영학부
    • 2. 발표 목차  파괴적 혁신이란 무엇인가? • 다른 산업의 사례 • 파괴적 혁신의 구성요소 • 의료분야의 사례  병원과 의사진료 모델의 변화  시사점  질의응답
    • 3. 미래의 의료는 어떤 모습일까?
    • 4. 의료가 어떻게 변하고 있는가?  소비자 중심의 의료(Consumerism) • 공급자-중심  질 관리  비용 관리  경험 관리 • 의사와 환자는 파트너 관계!  지식(전문성)의 民主化(大衆化) • 환자(및 보호자)가 자신의 데이터를 소유하고자 함. • 전문지식의 범용화(commoditization of expertise)  건강(의료) 솔루션 개발/이용의 폭발적 증가  협동과 커뮤니케이션의 강화 • 여러 의료전문직이 팀을 이루어 환자를 돌봄. • 여러 환자가 서로를 돕기 위해 협력함.
    • 5. (파괴적) 혁신이란? Improvement vs. Innovation Technology vs. Business Model Sustaining vs. Disruptive Centralization vs. De-centralization
    • 6. 컴퓨터산업: 중앙화와 탈중앙화(Decentralization)
    • 7. 파괴(Disruption)와 탈중앙화를 통한 접근성의 향상 Incumbents dominate sustaining battles Performance 45% on $250,000 60% on $500,000 Time Entrants typically win at disruption Time 40% 20% on $2,000 Copyright Clayton M. Christensen
    • 8. 중앙화-탈중앙화 패턴은 여러 산업의 공통적인 현상! Long-distance telecommunication Higher education Music recording & distribution Movies / Video Retailing Steelmaking
    • 9. 사업모델의 파괴는 접근성의 향상과 가격인하, 기업 및 경제 성장의 지배적인 기전! 과거 • Ford • Department Store • Digital Equipment • Delta • JP Morgan • Xerox • IBM • Cullinet • AT&T • Sony DiskMan • Japan 현재 • Toyota • Wal-Mart • Dell • Southwest, RyanAir • Fidelity • Canon • Microsoft • Oracle • Cingular • Apple iPod • Korea, Taiwan, HK 미래 • Chery/Tata • Internet retail • RIM Blackberry • SkyWest, Air taxis • ETFs • Zink • Linux • Salesforce.com • Skype • Cell Phones • China, India
    • 10. 파괴적 혁신의 구성요소
    • 11. 사업모델이란 무엇인가? THE VALUE PROPOSITION: A product that helps customers do more effectively, conveniently & affordably a job they’ve been trying to do PROFIT FORMULA: Assets & fixed cost structure, and the margins & velocity required to cover them RESOURCES: People, technology, products, facil ities, equipment, brands, and cash that are required to deliver this value proposition to the targeted customers PROCESSES: Ways of working together to address recurrent tasks in a consistent way: training, development, manufactu ring, budgeting, planning, etc.
    • 12. 서로 비슷한 사업모델을 가지고 수익과 차별화를 추구하기 위해 직접경쟁을 하면 항상 비용은 증가한다. Other examples: • Computers • Colleges • Investment Advisory • Retailers
    • 13. 중앙화에 이은 탈중앙화 패턴은 보건의료분야에서 이제 시작이다! 외과수술 전문적인 진료 가격을 떨어뜨리는 것은 파괴적 탈중앙화를 통해 성취됨.
    • 14. 파괴적 의료혁신 사례: 혈관성형술의 성장 Estimated Inpatient Cardiovascular Procedures, 1979-2002 000s of procedures 1,400 CAGR 1995-2002 Balloon Angioplasty/Stenting 15.69% 1,200 1,000 800 Bypass 600 -1.51% 400 200 0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 . Source: United States Centers for Disease Control and Prevention National Hospital Discharge Survey; Innosight analysis
    • 15. 허혈성 심질환 치료에 대한 “동기의 비대칭” High 진단과 치료의 복잡성 “When angioplasty was introduced, it captured the imagination of cardiologists and surgeons differently. Surgeons were skeptical about this new procedure. They were used to seeing small arteries in the operating room and questioned how one would be able to introduce a small catheter into the femoral artery, navigate it via the left main coronary artery into a distal vessel, and dilate it. Cardiologists saw this as an incredible opportunity to treat patients with ischemic heart disease.” Low 시간 —Chief, Division of Cardiothoracic Surgery, Miami, Florida
    • 16. 파괴적 혁신의 세 가지 촉진요인 2. Business model Innovation
    • 17. 파괴적 혁신은 높은 가치의 (값비싼) 전문지식이 일반화 될 때 촉진된다! Experimentation & Problem-solving Probabilistic Pattern Recognition Intuitive Medicine Empirical Medicine Rules-Based Precision Medicine Evidence-based medicine Technological Enablers of Disruption are Molecular Diagnostics, Imaging Technology, and Data Analysis
    • 18. 종합병원의 사업모델은 잘못되었다? Value Proposition: Don’t know what’s wrong? We can address any problem you bring Profit formula Resources Processes
    • 19. Turning machines Hobbing department A starts here Tapping equipment Annealing furnace Boring machines Storage Path taken by product B Cut-off saws De-burring machines B starts here Stamping machines Office area Shipping Department Polishing Dept.
    • 20. Overhead Burden Rate 규모의 경제성 vs. (생산라인) 복잡성의 비용 10.0 10 Cost of Complexity: Burden rate increases 27% for each doubling of product families 8.0 (20) 6.0 (4) 5.0 Pontiac Essex (4) Lima (10) Saginaw 4.0 (5) Tiffin Sandusky 3.0 (2) Lebanon (10) (6) Fremont 16 product families 8 product families (2) 4 product families Maysville 2.0 2 product families Economies of Scale: Burden rate drops 15% for each doubling 1.0 1 product family 1 10 10 20 40 100 80 100 160 320 Plant Scale (sales in $millions) 1000
    • 21. 병원의 사업모델은 “한 지붕 세 가족”? Solution Shops • Consulting firms • High-end law firms • R&D organizations • Diagnostic & intuitive activities of hospitals Fee for Service Value-adding process businesses • Manufacturing • Education • Food services • Medical procedures following diagnosis Fee for Outcome Facilitated Networks • Telecommunications • Insurance • eBay • Provider and patient communities Fee for Membership
    • 22. 보건의료전달의 파괴적 혁신 (공급자의 수준과 의료제공장소의 변화)
    • 23. 종합병원과 전문병원의 비용 격차 - 원인은 어디에? Shouldice Hospital (hernia repair) General Hospital (U.S. Typical) Cost of materials & supplies $100 $300 Cost of direct labor $600 $670 Overhead burden $1600 $6030 Total cost for equivalent length of stay $2,300 $7,000 # service families offered 1 75 2.7 9.0 Overhead burden rate
    • 24. 의사진료의 파괴적 혁신
    • 25. 시간이 지나면서 품질과 성능의 정의는 바뀌고, 새로운 사업모델의 필요가 생겨난다. Performance General hospitals, physician practices Employ the best expertise and deploy the best technologies Diagnose the underlying cause quickly and accurately to get to a precise and predictably-effective therapy Retail clinics, care directed by nurse practitioners, patient self-management Time
    • 26. 파괴적 사업모델을 둘러싼 새로운 상업생태계의 출현 Wellness programs Telehealth / e-visits Wireless health devices Telecommunications and Home monitoring Precision diagnostics Retail clinics Information management and decision-making tools Medical homes and care teams Hospital at home
    • 27. 의학의 본질적 변화에 따른 규제의 변화
    • 28. 시사점과 향후 과제  현실적 제약 • 과잉규제? – 파괴적 혁신제품의 사회적 수용성 문제 • 중간기술 – 불치병의 불완전 치료  비용 증가 • 파괴적 혁신  수요 창출 (소비 증가)  지출 증가  한국적 상황의 특수성 • 전국민건강보험(universal pop. Coverage) - 수요독점 • 일차의원에 대한 높은 접근성 vs. 대형병원 환자 쏠림 현상  Reference dependence & Risk aversion  Status Quo  의료의 질을 보는 관점의 변화 필요 (Trade-off)  Skate to where the puck will be!
    • 29. 감사합니다 ehealth@inje.ac.kr @BaeSungYoon