醫療產業供應鏈現況與未來 中山醫學大學醫療產業科技管理學系 廖宏昌 教授兼任系主任
供應鏈管理重要議題 -1 o 一般供應鏈最佳化問題考慮因素 物流議題：總系統成本 o 醫療供應鏈最佳化問題考慮因素 醫療議題：病人安全 物流議題：總系統成本
供應鏈管理重要議題 -2 o 一般半成品及產品特性 競爭市場 o 醫療藥品特性 服務業無半成品及產品 獨占性：藥品受專利期限保障 寡占性：藥品受專利期限保障，但有其他藥品可取 代性 競爭性：已無專利期限保障
供應鏈管理重要議題 -3 o 一般產業與供應商關係 合 作 —愈緊密愈好 o 醫院與供應商關係 獨占性：合 作 —愈緊密愈好 寡占性：合作 競爭性藥品：競標
供應鏈管理重要議題 -4 o 一般產業物流配送 強調 JIT o 醫療產業物流配送 藥品血液配送 JIT可 ? 安全存量重要性
供應鏈管理重要議題 -5 o 一般產業供應鏈 系統成本計算方試 單一 (多 )供應商 +單一製造商 +顧客配送 醫療產業 單一藥品供應商 +醫院策略聯盟 o
如何促使醫療供應鏈成功 o o o 醫療部藥品採購方式 藥品庫存管理 溝通、再溝通 醫院文化 醫療專業術語 醫院管理人員角色
The APP strategies selected in SCM of the hospital Publish in International Journal of Services and Technology Management
Abstract-1 o This paper used the real case, Taiwan’s Middle Alliance of Department of Health (TMADH), to explore the selection of suitable strategies of aggregate production planning (APP) in the supply chain management (SCM) of the hospital. The simulation method was used to simulate the six different APP’s strategies for further evaluating the results of multiple objectives —total cost (TC), average service level (S. L), and average changes of production rate (P. R).
Abstract-2 o This paper used the method of TOPSIS and fuzzy linguistic to compare different weights in different objectives to obtain the selecting sequence of the APP strategies for the decision-maker in the hospital’s SCM, The result shows that the decision-maker only needs to apply the historical data for the APP strategy’s planning to obtain the superior solution. That is, decreasing the complexity of decision process for selecting APP strategy as the production policy of SCM is the primary contribution in this paper.
Statement of the APP problem of TMADH -1 Fong-Yuan Hospital Information flow Yun-Lin Hospital Material flow Taichung Hospital Changhua Hospital Distribution Center (APP module) Nantou Jungshing Hospital Tsao-Town Psychiatric Center Taichung Chronic Disease Control Institution Transportation Pharmacies
Statement of the APP problem of TMADH -2 o The TMADH includes seven public hospitals —Fong-Yuan Hospital, Yun-Lin Hospital, Taichung Hospital, Changhua Hospital, Nantou Jungshing Hospital, Tsao-Town Psychiatric Center, and Taichung Chronic Disease Control Institution—and every hospital must use the Internet platform to purchase medical products. The distribution center is established in a virtual organization—computer center. These seven hospitals’ purchasing system to computer center is called e-health purchasing system.
Statement of the APP problem of TMADH -3 o when the hospital wants to procure medical products, purchasing professionals use the e-health purchasing system to order the purchasing items. JIT (just-intime) is designed in the delivery system. In addition, in order to avoid the shortage of medical products, the inventory is set in the contracting pharmaceutical companies. So, this paper is to connect the e-health purchasing system to the pharmaceutical companies, and to consider the transportation of medical products for hospitals’ demand in order to construct the TMADH’s SCM.
Statement of the APP problem of TMADH -4 o Three main viewpoints are established for the TMADH’s SCM. One is “to eliminate waste, ” another is “to benefit from discount, ” and the other is “to handle the channel. ” What is “to eliminate waste? ” Based on the structure of alliance, the size of every public hospital’s warehouse is eliminated as soon as possible and the inventory is set in the pharmaceutical companies. Additionally, hospitals should consider not only the cost but also, most importantly, the patient’s safety. Therefore, the enhancing service level for most hospitals and for emergent use would also be required.
Statement of the APP problem of TMADH -5 o “To benefit from discount” means that the distribution center computes the APP’s production quantity. With the “benefit from discount” equation, the hospital can decrease the unit price of medical products. “To handle the channel” means that the distribution center can further understand the contracting suppliers (pharmaceutical companies) in the reliability and coordination of supply and transportation. According to theory of JIT, the suppliers are evaluated in order to obtain the appropriate numbers of suppliers.
Statement of the APP problem of TMADH -6 o The seven public hospitals send the demands of medical products through the network to the distribution center; then after collecting the demand data, the distribution center computes the APP’s production policy to obtain these medical products (the discount quantity is considered here in order to obtain the benefit from the saving cost) through the Internet transmitting to pharmaceutical companies.
Statement of the APP problem of TMADH -6 o Additionally, the operation mode of material flow is that pharmaceutical companies directly transport the medical products to these seven hospitals. The transportation quantity is 50 lots for each vehicle. Every lot has 200 medical products. Owing to the different medical products of the same product family, the different medical products have the same the package size. The patient safety is the most important factor in the public hospital. So, if the transportation quantity is less than 50 lots, these medical products also need to be delivered.
Statement of the APP problem of TMADH -7 o This paper selects the appropriate objectives from the (Masud and Hwang, 1980; Krajewski and Ritzman, 1990; Nam and Logendran, 1992; Wang and Fang, 2001; Chen and Liao, 2003) which are 1) To maximize net profit, 2) To maximize utilization of production resource, 3) To maximize customer service, 4) To minimize inventory level, 5) To minimize the changes of production rate, and 6) To minimize the changes of workforce level.
Statement of the APP problem of TMADH -8 o Then, after considering the SCM of TMADH, the appropriate multiple objectives are 1) To minimize total cost (TC), 2) To maximize average service level (S. L), and 3) To minimize average changes in production rate (P. R). The objective of “to minimize total cost” includes the purchasing cost, inventory cost, setting cost, and transportation cost.
Research method-TOPSIS o In this paper, the authors used TOPSIS to solve the MADM problem of selecting the APP strategy’s sequence. TOPSIS, which was developed by Yoon (1980) and Hwang et al. (1981, 1995), is popular in using an intuitive principle to solve MADM problems in the last two decades. With TOPSIS, the optimal alternative is closest to the ideal solution and furthest from the negative-ideal solution. To sum up, the ranking of alternatives in TOPSIS is based on “the relative similarity to the ideal solution”, which avoids the situation of having same similarity to both ideal and negative-ideal solutions.
C=0. 5 C=0. 7 C=0. 6 * C=0. 9 C=0. 8 A v 2 S We igh ted att rib ute V 2 - v 2 * + v 2 2 0. 1 - v 2 A - v 1 0. 3 0. 4 - - * v 2+ v 2 2 Weighted attribute V 1 * v 1 *
Fuzzy linguistic for the APP’s six strategies-1 o The decision-maker maybe faces the conflict among the objectives--Min TC, Max S. L, and Min P. R, a different measurement unit for each objective, and a difficulty in assigning a set of weights based on relative importance to each objective. This paper uses the fuzzy linguistic to solve these problems.
Fuzzy linguistic for the APP’s six strategies-2 o the fuzzy ranking method is used to transform the crisp scores to the fuzzy numbers. According to the fuzzy numbers, the relative high, medium, and low importance is in the simplest scale 3. The fuzzy numbers of scale 3 show the high is 0. 833, the medium is 0. 500, and the low is 0. 166. In this paper, by a simple calculation, the authors normalize these 3 fuzzy numbers as the fuzzy weights of TC, S. L, and P. R. The normalized fuzzy weights can be 0. 5557 , and the other two fuzzy weights are 0. 3336 and 0. 1107.
Fuzzy linguistic for the APP’s six strategies-3 o In this paper, the authors use the 1000 simulation runs for each APP strategies and to obtain the average TC, SL, and PR; then the fuzzy weights are assigned to the three objectives, and TOPSIS is calculated for the selecting sequence of APP strategies for the practical application.
Conclusion-1 o Using S 6, S 3, or S 2, these three strategies are based on historical demand data. That is, the decision-maker can simplify the APP selected strategies; it is not necessary to formulate the complicated model as many researches to solve the complicated APP problems of the real case of the hospital’s SCM.
Conclusion-2 o With the special case for the comparison of the results of ANOVA for single objective and the results of TOPSIS for “the consideration of multiple objectives in which only one objective is especially important”, it shows that there are some differences in the selecting sequence for APP strategies. The reason lies in that ANOCA is assumed as the type I error, while TOPSIS is not.
Conclusion-3 o Finally, future study can further extend the relative SCM model, increase some criteria such as average time of shortages or average number of shortages periods, capture other variables, or tradeoffs that may exist in a complicated hospital’s problem of SCM.
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