本研究旨在模擬未來實施診斷關聯群（DRGs）支付制度–「前」、「後」醫療費用之差異情形及其主要影響因子與因應之道，期望藉此提供最佳診療模式以作為未來其他個案及各院調整或改變醫師診療行為及健保局修訂支付標準之參考，以減少不必要的資源浪費。本研究以北部某區域醫院自2004年7月至2005年6月之住院病患為調查對象，依照DRGs編碼找出案例數最多之病例，亦即為「DRG09102–單純性肺炎及胸（肋）膜炎，年齡0～17歲，無合併症及併發症，屬MDC4–呼吸系統之疾病與病患」，再透過“去極值法”及“標準差去極值法”等進行資料篩選，最後得到樣本數共556筆。研究結果顯示，未來若實施DRGs支付制度，健保局所公布之支付標準草案的醫療費用將明顯低於目前個案醫院所申報之健保費用，其影響因子分別為個人特質之病患年齡與住院天數，以及特殊診療特質之有無特殊用藥（抗生素注射劑-Zinacef）、有無特殊檢查∕檢驗（血液培養、特異過敏原免疫檢驗-CAP Panel及呼吸融合細胞病毒檢查-RSV Screening）及有無特殊處置（氧氣帳使用、兒童經皮靜脈導管置入術）等變項。本研究建議未來醫院可控制該項DRGs之病患住院天數、減少“抗生素注射劑-Zinacef”之使用量及“氧氣帳使用”之處置，同時在決定執行“血液培養”檢驗前能有更週全的考慮與評估，以降低醫療費用。

This research was aimed at simulating, and exploring medical expense variables, together with the main factors and responses before and after future implementation of The Diagnosis-Related Group (DRGs) payment system. It is expected to provide the best diagnosis and treatment model as a reference for future cases, also medical staff requirements in hospitals, and adjusting medical staff diagnosis, together with the payment standard [modified by The Bureau of National Health Insurance] to reduce unnecessary waste of resources. This study examined the treatment of a target group of 556 hospitalized patients aged from 0-17 years old in chosen distric hospitals in Northern Taiwan from July, 2004 to June, 2005 and found that in most case reports according to The DRGs code were referred to as DRG09102 simple pneumonia and pleurisy, withouth mention of any combined diseases or complications, which is MDC4 disease of the respiratory system. The research further used the Skipped Huber Method for data screening. In the future, if the DRGs payment system is implemented, the medical expenses payment standard draft [announced by The Bureau of National Health Insurance] will significantly lessen the present health insurance expenditure declared by the case hospitals. The main factors taken into account were respectively, the patients ages, and the number of days in hospital with or without specific medication (antibiotics injection-Zinacef), with or without specific analysis (blood culture, extraordinary allergen immunization-CAP Panel and RSV Screening) and with or without specific treatment (use of oxygen tent and transdermal venous catheter for children). This study suggests that in the future, hospitals should do their utmost to control the number of days of the DRGs patients hospitalization, reduce the use and amount of antibiotics injection-Zinacef and the use of oxygen tents and give more thorough consideration before deciding to execute blood culture examination, so as to reduce expenses incurred. Finally, we suggest that if, after hospitals were to implement The DRGs payment system, they must review and modify the clinical paths set up at present in order to control expenditure more efficiently and increase the operational benefits of the hospitals.