醫師是診治病人團隊的中心，身負著醫療品質、病人安全、甚至是健保費用撙節與防範健保不當刪減醫療費用等的責任。如何遴選出年度最有價值的醫師，是醫院管理者所面臨的問題。 利用健保住院2003年1至8月份申報資料，對某一醫學中心71位醫師6525件一般案件住院病例，歸判出DRGs，再以WINSTEPS電腦軟體進行各費用平均每日申報金額的Rasch部份給分模式之試題分析，以（1）效率及（2）費用核減風險防範(FIT)的二能力構面，做為遴選最有價值(MVP)醫師的依據。研究發現17項目費用（效率能力試題），可以分作二個向度因素。分別再對此二效率向度（因素）的FIT統計值納入單一向度檢測分析，以估計出各住院病例的FIT能力，將效率及FIT能力取其平均而為年度MVP選拔的評分標準。 研究發現該醫院的年度MVP由一般外科的醫師獲得（logit=1.20），各醫療科別間的效率或FIT能力及總得分皆呈顯著性的差異（p<0.01）。住院天數與FIT、效率或MVP總分呈負相關；FIT分數與MVP總分高度相關（Pearson γ=0.84）而與其他呈負相關，相對於醫療總費用對其他的相關性呈明顯的對比，表示效率與費用呈正比而與住院天數呈反比。FIT愈佳的病歷有費用或住院天數愈低的表徵。Rasch分析提供醫院選拔健保年度MVP醫師及醫療費用或成本分析上一個簡易可行的工具，後續研究可對健保實際核減病例，再參考本研究的FIT敏感指數，以實際驗證其關聯程度。

Acting as a key role of patient treatment in a hospital, physician shoulders the responsibility of medical quality, patient safety, cost containment on health care, and even of the medical expenses deductible less. Rasch analysis derived from Item Response Theory (IRT) could help choose year of most valuable doctor as a key topic to which all hospital mangers worth discussing. We analyzed the data of 6,525 inpatients discharges cases treated by 71 physicians on health insurance report form January to August in 2003, and then grouped DRGs codes and put various daily expenses of each discharge into Rasch analysis WINSTEPS computer software in a bit to examine whether a single construct existed and items FITted Rasch model. The results were shown that 2 factors were explored as efficiency dimensions. FIT latent variable was also obtained after 2 efficient factors were developed and was combined with total efficiency factors to be a criterion of MVP physician selection. A doctor working for general surgery department was selected as MVP physician (logit=1.20). Statistically significant differences among medical department were found in its abilities of efficiency, FIT or aggregated scores (p<001). The Stay of length had a negative relationship with those abilities of FIT, efficiency and aggregated scores. There were both high and positive Pearson relation coefficients (Pearsonγ=0.84) existed between FIT and MVP criterion scores. Those discharged cases with higher FIT scores were accompanied with less medical expenses or/and shorter stay of length. Rasch analysis provides the hospital not only to select health care giver year of MVP physician but also to help cost management analyzed simpler and more feasible than ever before.