到底CMS-DRGs如何支付醫院？其相對權值又是如何計算？

Payment System of CMS-DRGs and Its Calibration of Relative Weights

健保局打算在2005年實施DRGs （ Diagnosis Related Grou阱，診斷關聯群）支付制度，透過相對權值（relative weights） 來進行醫療費用的償付，籍以抑 制日漸高漲的財務壓力。DRGs 最先由美國Medicare （老人及殘障保險）從 1983年開始對急性醫院住院病患採取的前瞻性支付制度口本文即在探討美國 目前負責Medicare 及Medicaid（低收入戶保險）之「老人和殘障保險及低收入 戶保險服務中心」之CMS-DRGs女口何利用相對權值來支付醫院、申報費用極端 個案之支付方式、特殊情況之加減額支付的種類、以及CMS-DRGs 相對權值的 計算方法，並且佐以範例說明。最後並討論台灣欲實施DRGs 支付制度時應注 意之處。

Planning implementation of DRGs (Diagnosis Related Groups) Payment System in 2005, the Bureau of National Health Insurance (BNHI) wants to reimburse hospital inpatient charges with relative weights in order to downsize the recent financial pressures. DRGs payment system, first used in USA Medicare insurance in 1983, is a successful acute inpatient prospective payment system. This paper introduces the DRGs payment system of Centers of Medicare and Medicaid Services (CMS), CMS-DRGs. The method of payment with relative weights and the outlier case payment are explained by examples, along with the add-on payment for special situations, and the calibration of relative weights. Finally, we suggest the attention points for BNHI implementation of the DRGs payment system in Taiwan.