住院診斷關聯群支付制度(Diagnosis Related Groups, DRG)是健保署自民國九十九年起分五階段實施的一種給付新辦法，屬於「包裹式給付」，其目的在於提升醫療品質與降低醫療費用。目前已經實施第一、二階段，但社會各界與輿論仍存在疑慮所以暫時無法全面實施。多數醫院在營運成本壓力下將DRG案件盈虧責任轉嫁給醫師，卻可能造成醫師的醫療或申報行為改變。
本研究分析骨釘拔除手術與闌尾炎手術兩項DRG案件，藉由實施前後各醫療費用、主診斷與申報手術碼的差異找出醫師的行為改變。不僅藉由醫院申報資料，更經逐筆病歷校正，還原疾病原貌，以降低誤差。研究發現在實施DRG制度後，兩項疾病的住院天數都有明顯減少，醫療成本費用上則有不同結果；醫師對病人的醫療行為改變不大，但在申報的行為會藉由調升疾病嚴重度或改變主診斷或手術碼以避免承受案件虧損壓力，而且屬於群體行為模式。
健保署推動DRG制度時應正視醫界承受之壓力，不可忽略醫院的因應方式與醫師的人性反射行為，以免讓醫療環境更加速崩壞。

Diagnosis-related Groups (DRGs) are prospective hospital bundled-payment systems that have been implemented by National Health Insurance Administration of Taiwan since the year of 2010. The DRG program consists of five stages with the goals to improve the quality of patient care and reduce inefficiencies of hospital resources. With the first two stages of the program having come into effect, the DRG program is temporally paused on progress because challenges on many levels remain unresolved. For instance, some problems have manifested so far: in trying to decrease the medical cost under the financial pressure, most hospitals have incentivized to pass onto physicians the responsibility for the cost beyond DRG reimbursements. As a result, it may induce desirable change on physicians’ practice patterns and the submitted claims.
This study is focused on two DRG cases of orthopedic implants removal and appendectomy. We aim to evaluate the change of physicians’ behaviors by comparing the variability of medical charges, the selection of principal diagnosis and procedure codes of the two operations before and after the inception of DRGs.
From the database of Chi-Mei Hospital DRG claims, we conducted an audit of each clinical record with an effort to represent the original appearance of the illnesses thereby minimizing the systematic errors. The result showed that the inpatient hospital stays and medical charges of the two diseases significantly decreased after the launch of DRGs. DRGs had little impact on the modification of physicians’ behavior in medical practice. However, it was found that physicians might adjust the severity level of illnesses, principal and secondary diagnoses, or procedure codes to avoid the stress of financial losses per se. It was accounted for the modified pattern of physicians’ group behavior.
While promoting DRGs, National Health Insurance Administration should face the problems with regard to the stress physicians are under by not ignoring hospitals’ corresponding financial solution, which led to physicians’ behavior modification out of human nature. The administrators should consider the factors altogether to sustain the medical environment from falling apart.

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