醫院對診斷關聯群之因應行為－－以美國為例

Hospital Behaviors in Response to Diagnosis-Related Groups--The USA Experience

美國自1983 年採取診斷關聯群（DRGs） 做為支付Medi 閃閃醫院住院費用 的工具，已抑制住院費用大幅上漲，並對醫院的住院財務造成很大街擊。為 了解醫院在診斷關聯群下所產生的反應，本文探討美國醫院因應診斷關聯群 的文獻，歸納出四類行為：績效提升（performance improvement） 、費用轉移 （cost shift） 、選擇病患（dumping） 、與診斷關聯群取巧（DRGαeep） 。其中 「績效提升」能為保險人、醫院、及病患創造三贏局面；「費用轉移」與「診 斷關聯群取巧」可能會影響費用控制效果；「選擇病患」易造成無利潤病患 的就醫可近性不足。建議台灣在未來實施診斷關聯群峙，應促使醫院採取績 效提升行為，讓健保局與醫院共同努力控制費用，並保障病患的醫療品質與 就醫可近性。

In 1983, Medicare introduced Diagnosis-Related Groups (DRGs) for inpatient. DRGs not only have contained the increasing inpatient expenditure of Medicare but also could change hospital behaviors. This review aims to classify the USA hospital behaviors in response to DRGs-which are performance improvement, cost shift, dumping, and DRG creep. Performance improvement could bring a triple win solution for the insurers, the hospitals, and the patients. However, cost shift and DRG creep might reduce the effect of expenditure controlling. Furthermore, dumping might limit the access to medical care. For cost, quality, and access, we suggest that the authority should encourage hospitals to adopt 'performance improvement when Taiwan implements DRGs in the future.