為了建立合理的疾病分類系統，健保局於2010年實施診斷關聯群制度，利用前瞻給付的方式，藉以達到節省醫療資源的目的，並增強醫院的管理意識。本研究以中部某醫學中心為研究對象，利用骨科部、心臟血管外科部、心臟內科部、婦女醫學部及兒童醫學部之醫師處置資料，探討2010年首次實施診斷關聯群制度至2014年7月再次導入第二階段診斷關聯群制度期間，階段性實施診斷關聯群制度與醫師財務績效的關聯性。首先，實證結果顯示相較於第一階段，第二階段診斷關聯群制度的實施與醫師的財務績效具有顯著負向關係，表示導入第二階段的診斷關聯制度，更多的醫療項目被包含在更嚴苛的給付規則內，降低了醫師的財務績效。接著，發現檢查收入比率與醫師的財務績效具有顯著正向關係，表示提高疾病診斷的精確度，有助於提高醫師的財務績效。研究結果也發現於第二階段診斷關聯群制度實施期間，提高檢查收入比率與醫師的財務績效具有顯著正向關係，顯示在更嚴苛的給付條件下，醫師更需透過提高診斷的精確度，來避免成本超支。最後，實證結果考量各部科之特性差異，因此將各部門獨立拆開測試並評估其結果，發現各部門存有交叉補貼的情形。 To establish a reasonable disease classification system, the National Health Insurance Administration has utilized diagnosis related groups (DRGs), a prospective payment system, since January 2010. The DRG payment system is expected to achieve the objectives of saving medical resources and enhancing the cost control management of physicians. This study collects data from a medical center in central Taiwan and uses the DRG monthly case reports from five divisions, namely, orthopedics, cardiology, cardiovascular surgery, gynecology and pediatrics, to examine the relationship between the phased implementation of DRGs and the financial performance of physicians. The empirical results indicates that: (1) the financial performances of physicians during the second phase of the DRG implementation were lower than they were during the first phase; (2) there was a significant and positive association between examine fees earned by physicians and that his/her financial performance; and (3)the relationship between examine fees earned by physicians and his/her financial performance was stronger during the second phase of implementation that it was during the first phrase. Finally, considering the idiosyncratic characteristics between divisions, this study reexamines the analyses mentioned above by divisions. The results indicate that there is cross-subsidization across divisions.
