Apr 20, 2014

服務貿易協議中關於老人福利機構

以下是個人對於服務貿易協議中關於老人福利機構開放的看法與建議。比較兩邊協議中平等互惠的地方,也從台灣現實環境下去思考。

此協議中提到"允許大陸服務提供者在臺灣以合夥形式設立小型老人及身心障礙福利機構。"只開放小型老人福利機構讓中國企業投資,但是小型機構在台灣的生態已經屬於營利單位或是準營利單位,可是中國開放台灣投資僅限於獨資民辦非企業單位投資,對此協議發現不是很對等的關係,來台灣投資可以營利,但到中國投資是做慈善事業。個人對於如果可以到中國以合資經營企業、中外合作經營企業或外資企業形式投入老人福利機構市場,這才是公平。

條文中提到"大陸服務提供者出資比例須低於 50%,不具控制力。" 出資比例低於50%以下不代表不具備控制力,不到50%還是可以具備控制力,個人對此建議出資比例不能成為最大股東,或是由會計師認可不具重大影響力。但為什麼不能使中國服務提供者成為最大股東,這有很多可以討論的,在此就不討論。

對於人員的調度,協議中提到"跨國企業內部調動人員係指被其他世界貿易組織會員的法人僱用滿一年,透過在臺灣設立的分公司、子公司或分支機構,以負責人、高級經理人員或專家身分,短期進入臺灣以提供服務的自然人。" 看似沒有太大的問題,來台灣的人只會有負責人、高級經理人或專家。問題在專家,「專家」係指組織內擁有先進的專業技術,且對該組織的服務、研發設備、技術或管理擁有專門知識的人員。專家包括,但不限於,取得專門職業證照者如果你是老人福利機構的經營者,你會派遣中國哪些"專家"來台灣呢? 是不是這些專家在台灣也需要符合基本薪資與繳納所得稅。

對於服務貿易協議中關於老人福利機構,台灣開放可以來營利,但中國卻只開放非企業單位;而出資比例需低於50%不能代表不具備控制力,應該要看是否具備重大影響力;人員的調度會造成所謂的專家來台灣工作。這些總總問題都是開放之後需要考量與面對。

服務貿易協議下的醫療產業

從服務貿易協議中的醫療服務業來看
提供大陸服務提供者捐助設立非營利的財團法人醫院,我們非常感謝服務貿易協議,讓中國的資金可以來台灣做慈善事業,身為台灣人非常感動。台灣醫院屬於非營利的財團法人,盈餘是無法轉出去,意思是醫院無法投資賺錢,真正從醫院賺到錢的是醫院供應鏈,負責醫院供應鏈的公司有些還進入股票市場。中國服務提供者可以捐錢給醫院,就合法地進到醫院影響決策,當然也包含採購決策。

可是單憑這一點開放還不夠,還要配合以下兩條批發交易服務業無操作員醫療設備之出租或租賃服務業。前者可以讓中國資金在台灣成立批發公司,負責醫院耗材與藥品的批發交易;後者讓中國資金在台灣成立醫療設備租賃公司,負責醫院醫療器材的租賃服務。藥品、耗材與設備的採購是醫院最精華多汁的肥肉。

中國資金來台灣捐助非營利的財團法人醫院,不是為了慈善的捐助,捐助醫院進入決策層,再配合藥品或耗材批發公司或是醫療設備租賃公司,將獲利從醫院中帶出來,這就是中國在醫療服務貿易的策略。

此外,中國資金進入台灣的醫療市場後,誰受益了。中國服務提供者帶著資金來台灣,如何用最快的方式打入台灣醫療市場,直接併購與醫院關係良好的台灣公司最快,所以服務貿易協議通過後,這些與醫院有良好關係的無形資產,待價而沽。中國資金進來之後,一些企業將獲得不少的資金,有些投資人可能也藉此光榮退場,經過一段時間的整合,我個人擔心的是會墊高這產業的創業門檻,讓台灣人在自己本土市場上創業更加困難。

Apr 10, 2014

An Experience of Trial Telehealth Service

The following is a brief of an old woman who used a telehealth service. Mrs. Wang-Lin is 70s years old and she has heart disease. She lives with her son, her son’s wife and children. She started to use a National Taiwan University Hospital telehealth service that included BabyBot machine in 2011 September. Before using the telehealth service, her health was not well and she has gone to ER several times. Then, she received a 2 weeks free trial of telehealth service. After the free trial, she continues to use it for one month.

The following are summary Mrs. Wang-Lin’s experience of using the telehealth service. I visited her several times during her trial. At beginning of trial, she told me that she hoped this service could help her health becoming more stable. She thought the expense of ER was higher than the telehealth service fee, so she thought telehealth service was a good choose. Besides, in order to take care her body, she was willing to learn to use BabyBot. After one month, she gave up using the telehealth service because it was not worth of NT3900 per month. First, she does not need medicine staff to tell her “the data of your blood pressure is a little higher than usual”. She said she takes blood pressure every day so she has already known what her normal blood pressure is. It is meaningless to send the vital sign to the hospital and to tell her something that she has already known. Second, she said if the blood pressure data is unstable, she will go to the closest hospital immediately. She doesn’t need anyone telling her. Finally, she said that she needed her son to assist her in operating BabyBot. Besides, she still cannot operate BabyBot by herself after one month trial.

In my opinion, the telehealth service still has two problems. First, the telehealth machine still difficult to use for the elder. Even though BabyBot has an innovative remote control, the elder can’t still use it by themselves. The most important, the telehealth service is less useful than consumers expected. Or the service is too general for consumers. I suggest telehealth service providers to think deeply what kind of services are consumers’ needs.