本研究以12家500床以上區域級醫院93年7～12月住院申報資料，分析其平均醫療費用、平均住院天數、各DRG項目之ABC區及核實區分布與費用給付、病例組合指標（CMI）、平均每件醫療費用（Base Rate）、DRG項目別費用變異係數（CV）值等資料綜合研判，以探討全民健保即將推行DRGs支付制度對區域級醫院可能的衝擊。研究結果發現，從整體預定支付成數來看，排除不同條件的三種支付方式對區域醫院整體預估減少點數最高15%，合計12家醫院每季約減少1.64億~4.15億，即每家醫院平均每季將減少1,362萬～3,452萬點，而前十大DRG項目總差額負債值平均每季為495萬~1,700萬點。主要原因為50%以上DRG項目均落在BC區、訂定單一點值過低、費用臨界點過於偏差。本研究同時也顯示DRG的組內變異高，同時有必要考量予以再分類。對於各區域醫院所產生的衝擊，各醫院有必要依據個別醫院的特性、疾病嚴重度或教學成本，對各DRG項目予以成本效益分析，並在目前DRGs規劃尚無法完全解釋現行費用變異情況下，爭取合理的個別費率，進而提早因應DRGs制度所帶來的衝擊。

Twelve regional hospitals voluntarily participated in this study. There regional hospitals were equipped individually with 500 beds or more and were located in six regions. Date colleted were from July 2004 to December 2004, for analysis of mean medical expense, mean hospital days, expenses of Diagnosis Related Groups (DRGs) cases paid and distributed section of ABC for DRGs different weight project, CMI, base rate coefficient of variation (CV) of the expenses of DRGs items for DRGs payment project. Then we may re-evaluate the influence of DRGs system promoted by NHI on regional hospitals. Analyses revealed that according to the payment percentage schedule, the three payment modes with different exclusions, the estimated reduction to regional hospitals is 15% as the highest. Reimbursement to these twelve hospitals vere reduced by 164 million points to 415 million points in one quarter, and the mean reduction for each hospital was 14 million points to 35 million points quarterly, on the average. For the top ten DRGs items, the negative sum difference is between 5 million points to 17 million points. The probable causes are that more than 50% of the DRGs items are in B and C section, the scheduled point value is too low; and the critical points for expenses and deviated. This study also revealed that variation within the DRGs group item based on the hospital’s characteristics, disease severity, and teaching costs, in order to seek reasonable rates for individual items and to confront the impact caused by the DRGs system in time while the current planned payment of DRGs are unable to explain comprehensively the variation of expenses in practice.