5. 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.
6. (파괴적) 혁신이란?
Improvement vs. Innovation
Technology vs. Business Model
Sustaining vs. Disruptive
Centralization vs. De-centralization
8. 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
9. 중앙화-탈중앙화 패턴은 여러 산업의 공통적인 현상!
Long-distance telecommunication
Higher education
Music recording & distribution
Movies / Video
Retailing
Steelmaking
10. 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
12. 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.
13. 서로 비슷한 사업모델을 가지고 수익과 차별화를
추구하기 위해 직접경쟁을 하면 항상 비용은 증가한다.
Other examples:
• Computers
• Colleges
• Investment Advisory
• Retailers
14. 중앙화에 이은 탈중앙화 패턴은
보건의료분야에서 이제 시작이다!
외과수술
전문적인 진료
가격을 떨어뜨리는 것은 파괴적 탈중앙화를 통해 성취됨.
15. 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
16. 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
17. 파괴적 혁신의 세 가지 촉진요인
2. Business model
Innovation
18. 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
19. 종합병원의 사업모델은 잘못되었다?
Value Proposition:
Don’t know what’s
wrong? We can address
any problem you bring
Profit formula
Resources
Processes
20. 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.
21. 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
22. 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
26. 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
27. 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
29. 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!
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?