∫∑∫√√≥π‘∑—»πå

°“√®à“¬§à“∫√‘°“√μ“¡√–∫∫°≈ÿà¡«‘π‘®©—¬‚√§√à«¡¢Õߪ√–‡∑»‰∑¬·≈–μà“ߪ√–‡∑»

Õ“≥—μ‘ «√√≥»√’* —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï**

* ”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬, ** ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘

1

∫∑§—¥¬àÕ °“√»÷°…“π’ȇªìπ°“√∑∫∑«π«√√≥°√√¡ ¡’«—μ∂ÿª√– ß§å‡æ◊ËÕ√«∫√«¡Õߧ姫“¡√Ÿâ‡°’ˬ«°—∫°“√„™â√–∫∫°≈ÿà¡«‘π‘®©—¬‚√§

√à«¡ (Diagnosis Related Group; DRG) ´÷Ë߇ªìπ√–∫∫·∫àß°≈ÿࡺŸâªÉ«¬·∫∫‡©’¬∫æ≈—π æ—≤π“‚¥¬ Robert Fetter ·≈–§≥–

∑’Ë¡À“«‘∑¬“≈—¬‡¬≈ ª√–‡∑» À√—∞Õ‡¡√‘°“ ‡¥‘¡™◊ËÕ Yale DRG ¡’°“√æ—≤π“·≈–„™â¡“√à«¡°«à“ ’Ë∑»«√√… ºŸâªÉ«¬∑’Ë®—¥Õ¬Ÿà„π

°≈ÿà¡ DRG ‡¥’¬«°—π®–‰¥â√—∫∫√‘°“√∑’Ë„™â∑√—欓°√¢Õß‚√ß欓∫“≈§≈⓬§≈÷ß°—π ¬Õ¥®à“¬™¥‡™¬μàÕ°“√√—°…“ºŸâªÉ«¬Àπ÷Ëß

√“¬§”π«≥®“°Õ—μ√“®à“¬μàÕ DRG (DRG-based rate) §Ÿ≥§à“πÈ”Àπ—° —¡æ—∑∏å ·≈–ªí®®—¬μ—«ª√–°Õ∫ª√—∫§à“∑’Ë¢÷Èπ°—∫

∫√‘∫∑¢Õß·μà≈–ª√–‡∑» √–∫∫°“√‡∫‘°®à“¬·∫∫ DRG ¡’«—μ∂ÿª√– ß§åÀ≈—°‡æ◊ËÕ„À⇰‘¥§«“¡‚ª√àß„  ·≈–‡æ‘Ë¡

ª√– ‘∑∏‘¿“æ¢Õß√–∫∫∫√‘°“√ “∏“√≥ ÿ¢ ®÷ߧ«√¡’°“√»÷°…“∂÷ߢâÕ¥’·≈–¢âÕ‡ ’¬Õ¬à“ß√Õ∫¥â“π‡æ◊ËÕ à߇ √‘¡ à«π∑’Ë¥’·≈–

Õÿ¥√Õ¬√—Ë«À√◊Õ·°â‰¢ à«π∑’Ë àߺ≈‡ ’¬μàÕ√–∫∫ “∏“√≥ ÿ¢

§” ”§—≠: °≈ÿà¡«‘π‘®©—¬‚√§√à«¡, §«“¡‚ª√àß„ , ª√– ‘∑∏‘¿“æ, º≈°√–∑∫

Abstract The use of the Diagnosis Related Group (DRG) on hospital inpatient payment in different coun-try contextsArnat Wannasri*, Samrit Srithamrongsawat***Health Insurance System Research Office, **National Health Security Office

This article aimed to gather the knowledge about Diagnosis Related Group (DRG). The DRG is anacute-inpatient classification system. Developed by Robert Fetter and his colleagues at Yale University, itwas initially called Yale DRG. The system has been used for over four decades. Patients in the same DRGgroup are provided similar services and the hospital’s resources. The DRG-base rate multiplied by therelative weight and country-specific adjustment factors determines the reimbursement amount. The mainpurpose of utilizing the DRG system in health financing is to increase the transparency and efficiency ofhospital services. The advantages and disadvantages of the payment method should be explored so as toimprove the system and minimize any negative impacts it may have on health financing.

Key words: Diagnosis Related Group (DRG), transparency, efficiency, impact

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557 ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢

°¿Ÿ¡‘À≈—ß·≈–‡Àμÿº≈

≈ÿà¡«‘π‘®©—¬‚√§√à«¡ À√◊Õ Diagnosis Related Group

(DRG) ‡ªìπ√–∫∫®—¥°≈ÿࡺŸâªÉ«¬ (patient classification

system) ª√–‡¿∑‡©’¬∫æ≈—π (acute inpatient) ∑’Ë∫àß∫Õ°

§à“‡©≈’ˬ§–·ππ —¡æ—∑∏å°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (Case Mix In-

dex; CMI) ¢Õß‚√ß欓∫“≈«à“„π¿“æ√«¡‚√ß欓∫“≈¡’

»—°¬¿“æ·≈–„™â∑√—欓°√„π°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬„πÕ¬Ÿà„π

√–¥—∫„¥(1) °“√„™â DRG ¡’®ÿ¥¡ÿàßÀ¡“¬‡æ◊ËÕ§”π«≥§à“√—°…“

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

2

欓∫“≈ºŸâªÉ«¬„π·∫∫√“¬§√—ÈߢÕß°“√πÕπ√—°…“„π‚√ß欓∫“≈

°“√®—¥°≈ÿà¡μ—ÈßÕ¬Ÿà¿“¬„μâ ¡¡μ‘∞“π∑’Ë«à“°≈ÿࡺŸâªÉ«¬∑’Ë¡’≈—°…≥–

∑“ߧ≈‘π‘° §≈⓬§≈÷ß°—π®–„™â∑√—欓°√À√◊Õ∫√‘°“√μà“ßÊ ¢Õß

‚√ß欓∫“≈À√◊ÕÀπ૬∫√‘°“√„π°“√√—°…“∑’˧≈⓬§≈÷ß°—π ‚¥¬

„π√–¬–·√°¡’°“√æ—≤π“√–∫∫°“√®—¥°≈ÿࡺŸâªÉ«¬‡©æ“–°√≥’

ºŸâªÉ«¬„π μàÕ¡“®÷ßæ—≤π“√–∫∫‡æ◊ËÕ„™â®—¥°≈ÿࡺŸâªÉ«¬πÕ° (am-

bulatory care)(2,3) ºŸâªÉ«¬∑’ËμâÕ߉¥â√—∫°“√øóôπøŸ (rehabilita-

tion)(4) ºŸâªÉ«¬∑’ËμâÕß°“√°“√¥Ÿ·≈√–¬–¬“« (long-term care) (5)

„πªï æ.». 2555 ª√–‡∑»‰∑¬„™â√–∫∫ DRG „π°“√®à“¬

§à“√—°…“欓∫“≈ºŸâªÉ«¬„π¢Õß√–∫∫À≈—°ª√–°—π ÿ¢¿“æ¢Õß

√—∞∑—Èß 3 √–∫∫ §◊Õ √–∫∫À≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ √–∫∫

ª√–°—π —ߧ¡ ·≈–√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√

·μà„π√Ÿª·∫∫·≈–Õ—μ√“®à“¬™¥‡™¬∑’Ë·μ°μà“ß°—π ∑—Èßπ’È Õ—μ√“∑’Ë

·μ°μà“ß°—π¢Õß·μà≈–√–∫∫‡°‘¥‡π◊ËÕß®“°μà“ߧπμà“ߧ‘¥

πÕ°®“°π—Èπ¬—ß¡’√“¬°“√∑’Ë·¬°®à“¬®“°√–∫∫ DRG ´÷Ëß·μ°

μà“ß°—π√–À«à“ß°Õß∑ÿπ¥â«¬ ‡™àπ √“¬°“√«— ¥ÿÀ√◊Õ°“¬Õÿª°√≥å

¢≥–∑’Ë∫“ß∫√‘°“√¡’°“√·¬°®à“¬®“°√–∫∫ DRG ‡≈¬ ‡™àπ

∫√‘°“√∑’Ë¡’°“√∫√‘À“√‡©æ“–¢Õß√–∫∫À≈—°ª√–°—π ÿ¢¿“æ·Ààß

™“μ‘ ‡ªìπμâπ(6)

°“√∑’Ë·μà≈–√–∫∫¡’«‘∏’®à“¬μ“¡ DRG ·≈–Õ—μ√“°“√®à“¬

∑’Ëμà“ß°—π π”¡“´÷Ëߧ«“¡°—ß«≈∂÷ß°“√‡≈◊Õ°ªØ‘∫—μ‘„π°“√„Àâ

∫√‘°“√®“°·√ß®Ÿß„®„π°“√„Àâ∫√‘°“√∑’Ëμà“ß°—π ¥â«¬§«“¡

μ√–Àπ—°·≈–„À⧫“¡ ”§—≠°—∫π‚¬∫“¬≈¥§«“¡‡À≈◊ËÕ¡≈È”

√–À«à“ß°Õß∑ÿπÀ≈—°ª√–°—π ÿ¢¿“æ(7) §≥–√—∞¡πμ√’®÷ß¡’¡μ‘‡¡◊ËÕ

«—π∑’Ë 19 ¡‘∂ÿπ“¬π 2555 ‡ÀÁπ™Õ∫μ“¡¢âÕ‡ πÕ¢Õߧ≥–

°√√¡°“√°”Àπ¥√–∫∫∫√‘À“√¬“ ‡«™¿—≥±å °“√‡∫‘°®à“¬§à“

μ√«®«‘π‘®©—¬ ·≈–§à“∫√‘°“√∑“ß°“√·æ∑¬å ¢âÕ∑’Ë 4.3 ‡√◊ËÕß°“√

ª√—∫Õ—μ√“°“√®à“¬μ“¡ DRG „À⇪ìπ‡Õ°¿“æ√–À«à“ß°Õß∑ÿπ(8)

‡æ◊ËÕ„Àâ°“√¥”‡π‘π°“√ªØ‘√Ÿª‡ªìπ‰ªÕ¬à“߇À¡“– ¡ ®÷߇ªìπ∑’Ë¡“

¢Õß°“√∑∫∑«π«√√≥°√√¡·≈–‡Õ° “√∑’ˇ°’ˬ«¢âÕß„π§√—Èßπ’È

‡æ◊ËÕ√«∫√«¡Õߧ姫“¡√Ÿâ„πª√–‡¥Áπ¥—ßμàÕ‰ªπ’ȧ◊Õ Àπ÷Ëß À≈—°°“√

§‘¥·≈–°“√æ—≤π“°“√®à“¬μ“¡√–∫∫ DRG „πμà“ߪ√–‡∑»  Õß

°“√π”√–∫∫ DRG ‰ª„™â„π°“√®à“¬§à“∫√‘°“√ºŸâªÉ«¬„π¢Õß

ª√–‡∑»μà“ßÊ ·≈–°“√°”Àπ¥Õ—μ√“®à“¬·≈–ªí®®—¬°”Àπ¥

Õ—μ√“®à“¬™¥™¥‡™¬·°à‚√ß欓∫“≈  “¡ °“√π” DRG ¡“„™â„π

°“√®à“¬§à“∫√‘°“√ºŸâªÉ«¬„π¢Õߪ√–‡∑»‰∑¬ ·≈–ªí≠À“¢âÕ‚μâ

·¬âßμà“ßÊ „π™à«ß∑’˺à“π¡“  ’Ë º≈°√–∑∫¢Õß°“√„™â√–∫∫ DRG

„π√–∫∫°“√§≈—ß “∏“√≥ ÿ¢

√–‡∫’¬∫«‘∏’»÷°…“

∫∑§«“¡π’ȇªìπ°“√∑∫∑«πÕߧ姫“¡√Ÿâ ª√– ∫°“√≥å°“√

„™â√–∫∫ DRG „π√–∫∫°“√§≈—ß ÿ¢¿“æ¢Õߪ√–‡∑»‰∑¬·≈–

μà“ߪ√–‡∑» ¢âÕ¡Ÿ≈‰¥â®“°°“√§âπ§«â“∫∑§«“¡«‘™“°“√

‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡ Àπ—ß ◊Õ√“™°“√®“°Àπ૬ߓπ/

°√–∑√«ß μ”√“ ·≈– ‘Ëßμ’æ‘¡æå ∑—Èß„πª√–‡∑»·≈–μà“ߪ√–‡∑»

®“°∞“π¢âÕ¡Ÿ≈ Cochrane, PubMed, WorldCat, WHO,

ScienceDirect ∞“π§≈—ߢâÕ¡Ÿ≈·≈–§«“¡√Ÿâ√–∫∫ ÿ¢¿“æ¢Õß

 ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ·≈–‡«Á∫‰´μå¢Õß°√¡∫—≠™’°≈“ß

‚¥¬°”À𥧔 ”§—≠ §◊Õ diagnosis related group(s) À√◊Õ

DRG(s) + countries, + °√¡∫—≠™’°≈“ß, + ª√–°—π —ߧ¡, +

√–∫∫À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“, +development, + im-

pact, + base rate, + evaluation ·≈– ◊∫§âπ‡Õ° “√‡æ‘Ë¡

‡μ‘¡®“°√“¬°“√‡Õ° “√Õâ“ßՑߢÕß∫∑§«“¡μâπ©∫—∫∑’ˇ°’ˬ«¢âÕß

‡æ◊ËÕ„À≥â¢âÕ¡Ÿ≈§√∫∂â«π∑’Ë ÿ¥

º≈°“√»÷°…“

1. ·π«§‘¥·≈–°“√æ—≤π“°“√®à“¬¥â«¬√–∫∫ DRG

√–∫∫ DRG ¡’≈—°…≥– ”§—≠ 4 ª√–°“√ §◊Õ Àπ÷Ëß °“√

®—¥‡°Á∫¢âÕ¡Ÿ≈°“√®”Àπà“¬ºŸâªÉ«¬°≈“¬‡ªìπß“πª√–®”  Õß

®”π«π°≈ÿà¡ DRG ¡’„πª√‘¡“≥∑’Ë®—¥°“√‰¥â  “¡ ·μà≈–°≈ÿà¡¡’

§«“¡ —¡æ—π∏å∑“ߧ≈‘π‘°  ’Ë ·μà≈–°≈ÿà¡¡’§«“¡§≈⓬§≈÷߇™‘ß

∑√—欓°√ §à“√—°…“(9) °“√®—¥°≈ÿࡺŸâªÉ«¬¥â«¬√–∫∫ DRG μâÕß

 “¡“√∂ª√–¬ÿ°μ儙≥Ⱇ∫‚√ß欓∫“≈∑ÿ°·Ààß ‚¥¬√–∫∫ DRG

§«√¡’§ÿ≥ ¡∫—μ‘ ”§—≠¥—ßπ’È(1)

1.1 °≈ÿࡺŸâªÉ«¬∑’Ë®—¥Õ¬Ÿà„π°≈ÿà¡„À≠àÀ√◊Õ°≈ÿ࡬àÕ¬

‡¥’¬«°—πμâÕß¡’§«“¡§≈⓬§≈÷ß°—π∑“ߧ≈‘π‘°

1.2 ºŸâªÉ«¬∑’Ë®—¥Õ¬Ÿà„π°≈ÿࡇ¥’¬«°—𠧫√„™â∫√‘°“√μà“ßÊ

¢Õß‚√ß欓∫“≈∑’˧≈⓬§≈÷ß°—π

Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

3

1.3 ºŸâªÉ«¬Àπ÷Ëß√“¬μâÕß®—¥‡¢â“°≈ÿࡇ¥’¬« ·≈–°≈ÿà¡

‡À≈à“π’ÈμâÕߧ√Õ∫§≈ÿ¡ºŸâªÉ«¬∑ÿ°√“¬∑’Ë√—∫°“√√—°…“„π‚√ß欓∫“≈

1.4 °“√®—¥°≈ÿࡺŸâªÉ«¬„™â¢âÕ¡Ÿ≈∑’Ë¡’Õ¬Ÿà·≈â«„π‡«™

√–‡∫’¬πºŸâªÉ«¬ ¢âÕ¡Ÿ≈‡À≈à“π’È —¡æ—π∏å°—∫ª√–‡¿∑¢Õß∫√‘°“√∑’Ë

ºŸâªÉ«¬μâÕß„™â‡π◊ËÕß®“°°“√‡®Á∫ªÉ«¬À√◊Õ°“√√—°…“

1.5 °“√®—¥°≈ÿࡧ«√„Àâº≈≈—æ∏å‡À¡◊Õπ°—π ·¡â«‘∏’„Àâ

√À— ∑“ß°“√·æ∑¬å®–μà“ß°—π

„π°“√®—¥°≈ÿࡺŸâªÉ«¬¥â«¬√–∫∫ DRG ¡’¢âÕ¡Ÿ≈ ”§—≠∑’Ë

μâÕß∑√“∫§◊Õ °“√«‘π‘®©—¬‚√§À≈—° ´÷Ë߇ªìπ°“√æ‘®“√≥“À√◊Õ

μ—¥ ‘π‚¥¬·æ∑¬å«à“‡ªì𠓇ÀμÿÀ≈—°∑’Ë∑”„À⇰‘¥§«“¡º‘¥ª°μ‘

μàÕ√à“ß°“¬ °“√«‘π‘®©—¬‚√§À≈—°¡’‰¥â‡æ’¬ß°“√«‘π‘®©—¬‡¥’¬«

‚¥¬°√–∑”‡¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“ °√≥’ºŸâªÉ«¬¡’À≈“¬‚√§ª√“°Ø

æ√âÕ¡°—π„Àâ∂◊Õ‚√§∑’Ë¡’§«“¡√ÿπ·√ß∑’Ë ÿ¥ ·≈–¡’°“√„™â∑√—欓

°“√„π°“√√—°…“¡“°∑’Ë ÿ¥‡ªìπ°“√«‘π‘®©—¬‚√§À≈—° °√≥’‰¡à¡’

°“√«‘π‘®©—¬‚√§‰¥â™—¥‡®π„Àâ∂◊Õ°≈ÿà¡Õ“°“√∑’Ë ”§—≠∑’Ë ÿ¥

‡ªìπ°“√«‘π‘®©—¬À≈—° πÕ°®“°°“√«‘π‘®©—¬‚√§À≈—°·≈⫬—ß¡’

μ—«·ª√ ”§—≠Õ◊ËπÊ ∑’Ëπ”¡“„™â®—¥°≈ÿà¡ §◊Õ ¢âÕ¡Ÿ≈§≈‘π‘° ‰¥â·°à

°“√«‘π‘®©—¬‚√§√Õß ·≈–‚√§Õ◊ËπÊ ‰¥â·°à ‚√§∑’ˇªìπ√à«¡¥â«¬

‚√§·∑√°´âÕπ À—μ∂°“√  ¿“æ°“√®”Àπà“¬ºŸâªÉ«¬ ¢âÕ¡Ÿ≈

ª√–™“°√»“ μ√å ‰¥â·°à Õ“¬ÿ·≈–‡æ»¢ÕߺŸâªÉ«¬ ¢âÕ¡Ÿ≈°“√„™â

∑√—欓°√‡æ◊ËÕ§”π«≥§à“¡“μ√∞“π ‰¥â·°à ®”π«π«—ππÕπ

·≈–§à“√—°…“∑’˺ŸâªÉ«¬∂Ÿ°‡√’¬°‡°Á∫®“°‚√ß欓∫“≈(10)

√–∫∫ DRG ¡’°“√æ—≤π“°«à“ ’Ë∑»«√√… ‚¥¬π—°«‘®—¬

¢Õß¡À“«‘∑¬“≈—¬‡¬≈∑’ˇ√‘Ë¡»÷°…“„π™à«ßª≈“¬ §.». 1960 ·≈–

·π–π”√–∫∫ Yale DRG „À⇪ìπ∑’Ë√Ÿâ®—°„π™à«ßª≈“¬ªï §.». 1970

μ√“∫®πªï §.». 1983 ª√–‡∑» À√—∞Õ‡¡√‘°“®÷߇√‘Ë¡„™â DRG

„π√–∫∫°“√‡∫‘°®à“¬§à“√—°…“欓∫“≈„π√–∫∫À≈—°ª√–°—π·∫∫

Medicare ´÷Ë߇ªìπ√–∫∫ «— ¥‘°“√√—°…“欓∫“≈ ”À√—∫°≈ÿà¡

ºŸâ ŸßÕ“¬ÿ¿“¬„μâ°“√∫√‘À“√ß“π¢Õß Health Care Financing

Administration (HCFA) ‡æ◊ËÕ§«∫§ÿ¡§à“„™â®à“¬¥â“π ÿ¢¿“æ

∑’ˇæ‘Ë¡ Ÿß¢÷Èπ(11)

2. °“√„™â√–∫∫ DRG „π°“√®à“¬§à“∫√‘°“√ºŸâªÉ«¬„π

2.1 °“√∂à«ß§à“πÈ”Àπ—° (DRG weight) ·≈–°“√

·ª≈ß§à“‡ß‘πμàÕÀπ૬ (monetary conversion)

°“√°”Àπ¥Õ—μ√“®à“¬¢Õß DRG ¢÷ÈπÕ¬Ÿà°—∫°“√∂à«ßπÈ”

Àπ—°´÷Ëߧ‘¥‡ªìπÀπ૬ ·≈–°“√·ª≈ß§à“‡ß‘π´÷ËßÕ“®°”À𥇪ìπ

®”π«π‡ß‘πÀ√◊Õ°”À𥇪ìπÀπ૬ ¢÷ÈπÕ¬Ÿà°—∫ªí®®—¬μ—«ª√–°Õ∫

ª√—∫§à“ (adjustment factors) °“√§”π«≥§à“πÈ”Àπ—°¢Õß DRG

¡’ 3 √Ÿª·∫∫„Àâ‡≈◊Õ° §◊Õ §à“πÈ”Àπ—° —¡æ—∑∏å (relative weight;

RW) Õ—μ√“®à“¬ (raw tariff) ·≈–§–·ππ¥‘∫ (score)(12)

√Ÿª·∫∫∑’ËÀπ÷Ëß ç§à“πÈ”Àπ—° —¡æ—∑∏åé À≈“¬ª√–‡∑» ‡™àπ

‡Õ ‚∑‡π’¬ øîπ·≈π¥å ‡¬Õ√¡π’ ‰Õ√å·≈π¥å  «’‡¥π(12) „™â°“√

§”π«≥§à“ RW À√◊Õª√—∫„™â§à“ RW ®“°ª√–‡∑»μâπ·∫∫ ‚¥¬

RW À¡“¬∂÷ß §à“‡©≈’ˬ°“√„™â∑√—欓°“√„π°“√√—°…“ºŸâªÉ«¬

·μà≈–°≈ÿà¡ DRG ‡¡◊ËÕ‡∑’¬∫°—∫§à“‡©≈’ˬ°“√„™â∑√—欓°√„π°“√

√—°…“ºŸâªÉ«¬ DRG ∑ÿ°°≈ÿà¡(13) °“√®–∑√“∫§à“ RW ¢Õß DRG

·μà≈–°≈ÿࡉ¥â®”‡ªìπμâÕß∑√“∫§à“„™â®à“¬¢Õß DRG ∑—ÈßÀ¡¥°àÕπ

‡¡◊ËÕ‰¥â§à“ RW ·≈â«®÷ß𔉪§Ÿ≥°—∫Õ—μ√“®à“¬μàÕÀπ૬∑’Ë¡’°“√

°”Àπ¥ ´÷Ëß·μà≈–ª√–‡∑»¡’Õ—μ√“μà“ß°—π(12)

√Ÿª·∫∫∑’Ë Õß çÕ—μ√“®à“¬é ª√–‡∑»∑’Ë„™â√Ÿª·∫∫π’ȉ¥â·°à

ª√–‡∑»Õ—ß°ƒ… Ω√—Ë߇»  ·≈–‡π‡∏Õ√å·≈π¥å °“√§”π«≥Õ—μ√“

®à“¬¢Õß·μà≈–ª√–‡∑»Õ“®Õ‘ßªí®®—¬∑’Ë·μ°μà“ß°—𠇙àπ

ª√–‡∑»Õ—ß°ƒ…°”Àπ¥Õ—μ√“®à“¬‡ªìπÕ—μ√“‡¥’¬«∑—Èߪ√–‡∑»

‚¥¬„™â°≈‰°≈μ≈“¥‡ªìπμ—«°”Àπ¥ (market forces factor;

MFF) °“√„™â MFF ¡’«—μ∂ÿª√– ß§å‡æ◊ËÕ®à“¬™¥‡™¬ à«π¢Õß

μâπ∑ÿπ∑’Ë¡‘Õ“®À≈’°‡≈’ˬ߉¥â„πæ◊Èπ∑’Ëμà“ßÊ ¢Õߪ√–‡∑»∑’Ë¡’§«“¡

·μ°μà“ß°—π MFF ¢÷ÈπÕ¬Ÿà°—∫¥—™π’¬àÕ¬ 3 μ—«§◊Õ §à“·√ß (labour

cost) ¥—™π’∑’Ë¥‘π (land index) ·≈– ¥—™π’Õ“§“√ (building

index)(14)

ª√–‡∑»Ω√—Ë߇» §”π«≥Õ—μ√“®à“¬·¬°√–À«à“ß‚√ß欓∫“≈

¿“§√—∞·≈–‚√ß欓∫“≈‡Õ°™π ‚√ß欓∫“≈¿“§√—∞§”π«≥

Õ—μ√“®à“¬®“°§à“∫√‘°“√∑“ß°“√·æ∑¬å·≈–∫ÿ§≈“°√∑“ß°“√

·æ∑¬åÕ◊ËπÊ μâπ∑ÿπ ”À√—∫°“√≈ß∑ÿπ„π°“√ª√–¥‘…∞姑¥§âπ

‡§√◊ËÕß¡◊Õ·æ∑¬å §à“¬“ ‡«™¿—≥±å·≈–‡§√◊ËÕß¡◊Õ·æ∑¬å ‚¥¬‰¡à

√«¡§à“¬“·≈–‡§√◊ËÕß¡◊Õ·æ∑¬å∑’Ë¡’√“§“·æß  à«π§à“ infrastruc-

ture/overhead ®–·¬°ÕÕ°¡“μà“ßÀ“° „π¢≥–∑’Ë°“√§”π«≥

Õ—μ√“®à“¬¢Õß‚√ß欓∫“≈‡Õ°™π‰¡à√«¡§à“·æ∑¬å ·μà√«¡§à“ in-

frastructure/overhead ·≈–§‘¥§à“°“√≈ß∑ÿπ„π°“√

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

4

ª√–¥‘…∞姑¥§âπ‡§√◊ËÕß¡◊Õ·æ∑¬å‡æ’¬ß√âÕ¬≈– 25(15)  à«πª√–‡∑»

‡π‡∏Õ√å·≈π¥å ´÷Ëß¡’√–∫∫ DRG ∑’Ë´—∫´âÕπ∑’Ëæ—≤π“¢÷Èπ‡Õß §◊Õ

The Diagnosis-treatment combinations (de Diagnose

Behandeling Combinaties; DBC) ®–§”π«≥ DBC tariffs

®“° ÕßÕߧåª√–°Õ∫§◊Õ §à“∫√‘°“√ ”À√—∫·æ∑¬å (honorarium

component) ·≈–μâπ∑ÿπ‚√ß欓∫“≈ (hospital cost com-

ponent)(16)

√Ÿª·∫∫∑’Ë “¡ 秖·ππ¥‘∫é °≈ÿࡪ√–‡∑»∑’Ë„™â§–·ππ

¥‘∫„π°“√§”π«≥§à“πÈ”Àπ—° DRG ‰¥â·°à ª√–‡∑»ÕÕ ‡μ√’¬

·≈–ª√–‡∑»‚ª·≈π¥å ª√–‡∑»ÕÕ ‡μ√’¬°”Àπ¥§à“§–·ππ¥‘∫

‡ªìπÕ—μ√“‡¥’¬«∑—Èߪ√–‡∑»·≈–‰¡à¡’°“√·¬°§à“§–·ππμ“¡√Ÿª

·∫∫°“√„Àâ∫√‘°“√ μà“ß®“°ª√–‡∑»‚ª·≈π¥å∑’˧‘¥§à“§–·ππ

·¬°μ“¡√Ÿª·∫∫°“√„Àâ∫√‘°“√ ‡™àπ elective cases, ∫√‘°“√

©ÿ°‡©‘π, ·≈– day cases(12) „πÕÕ ‡μ√’¬°“√§”π«≥§à“§–·ππ

LDF (√–∫∫ DRG ¢Õߪ√–‡∑»ÕÕ ‡μ√’¬) ∂Ÿ°°”Àπ¥¥â«¬ 2

Õߧåª√–°Õ∫§◊Õ performance component ´÷Ëß√«¡°“√„™â

∑√—欓°√∑—ÈßÀ¡¥„π°“√√—°…“ºŸâªÉ«¬ ·≈– day component

´÷Ëß√«¡§à“„™â®à“¬∑—ÈßÀ¡¥„π√–À«à“ß∑’˺ŸâªÉ«¬√—°…“μ—«„π‚√ß

欓∫“≈∑’ˉ¡à “¡“√∂ªíπ‡¢â“°—∫ à«π·√°(17)  ”À√—∫ª√–‡∑»

‚ª·≈π¥å§à“§–·ππ¥‘∫∂Ÿ°§”π«≥‚¥¬Õâ“ßÕ‘ß®“°√“§“¢Õß

∫√‘°“√μà“ßÊ „π∫—≠™’¬âÕπÀ≈—ߢÕߺ≈º≈‘μ‚√ß欓∫“≈ (hospi-

tal products) ·≈–§à“§«“¡∂’Ë —¡æ—∑∏å (relative frequency)

¢Õß∫√‘°“√π—ÈπÊ „π·μà≈–°≈ÿࡺŸâªÉ«¬„π√–∫∫ JGP (√–∫∫ DRG

¢Õߪ√–‡∑»‚ª·≈π¥å) ®–μâÕ߇ª√’¬∫‡∑’¬∫§à“§–·ππ (JGP

score) °—∫Õ—μ√“ à«π√“§“ (price ratio) ¢Õß Healthcare

Resource Group system (HRGs) ¢Õߪ√–‡∑»Õ—ß°ƒ…¥â«¬

‡π◊ËÕß®“°ª√–‡∑»‚ª·≈π¥åπ”√–∫∫ HRGs ¢Õߪ√–‡∑»

Õ—ß°ƒ…¡“ª√–¬ÿ°μå„™â(18) ‡¡◊ËÕ‰¥â§à“§–·ππ¥‘∫μàÕÀπ૬ DRG

·≈â«®÷ß𔉪§Ÿ≥°—∫§à“§–·ππ (point value) ∑’Ë¡’°“√º—π‡ªìπ

§à“‡ß‘πμàÕÀπ÷Ëߧ–·ππ‰«â·≈â« ‡™àπ 1 §–·ππ¡’Õ—μ√“®à“¬∑’Ë 30

¬Ÿ‚√ ´÷ËßÀ¡“¬§«“¡«à“‚√ß欓∫“≈∑’Ë„Àâ∫√‘°“√ºŸâªÉ«¬°≈ÿà¡ DRG

∑’Ë¡’§à“πÈ”Àπ—°‡∑à“°—∫ 1 §–·ππ ®–‰¥â√—∫Õ—μ√“®à“¬∑’Ë 30 ¬Ÿ‚√(12,19)

2.2 Õ—μ√“®à“¬™¥‡™¬¥â«¬√–∫∫ DRG §√Õ∫§≈ÿ¡∑ÿ°

∫√‘°“√À√◊Õ‰¡à

°“√π”‡Õ“√–∫∫ DRG ‰ª„™â®à“¬§à“∫√‘°“√ºŸâªÉ«¬„π¡’

§«“¡·μ°μà“ß°—π„π·μà≈–ª√–‡∑» °“√√«∫√«¡¢âÕ¡Ÿ≈„π 12

ª√–‡∑»„π¬ÿ‚√ªæ∫«à“ √“¬‰¥â¢Õß‚√ß欓∫“≈∑’Ë¡“®“°√–∫∫

DRG ¡’§à“μ—Èß·μàª√–¡“≥√âÕ¬≈– 20 ®π∂÷ߪ√–¡“≥√âÕ¬≈– 96

¢Õß√“¬‰¥â‚√ß欓∫“≈∑—ÈßÀ¡¥ π—Ëπ· ¥ß«à“‚√ß欓∫“≈¡’√“¬

‰¥â®“°«‘∏’°“√®à“¬·∫∫Õ◊Ëπ¥â«¬ ‡™àπ ®à“¬μ“¡ª√‘¡“≥∫√‘°“√ (fee-

for-service) ®à“¬μ“¡«—ππÕπ (per day) ®à“¬‡æ‘Ë¡‡μ‘¡„Àâ°—∫

∫√‘°“√∫“ߪ√–‡¿∑ (additional payment)(12) ‡ªìπμâπ ‡Àμÿº≈

∑’ˬ—ߧߡ’°“√„™â«‘∏’®à“¬√Ÿª·∫∫Õ◊Ëπ√à«¡¥â«¬ ·¡â®–¡’°“√„™â√–∫∫

DRG „π°“√®à“¬§à“∫√‘°“√ºŸâªÉ«¬„π  √ÿª‰¥â¥—ßπ’È

1. §à“„™â®à“¬∫“ß√“¬°“√‰¡à‰¥â√«¡Õ¬Ÿà„π°“√§”π«≥

§à“πÈ”Àπ—° DRG ·μà·√° ‡™àπ §à“∫√‘°“√ ”À√—∫·æ∑¬å §à“„™â

®à“¬ ”À√—∫‡§√◊ËÕß¡◊Õ·≈–¬“∑’Ë¡’√“§“·æß„πª√–‡∑»Õ—ß°ƒ…∑’Ë

®–¡’°“√·¬°ÕÕ°¡“μà“ßÀ“°(14)

2. °“√®à“¬‡æ‘Ë¡‡μ‘¡ ”À√—∫∫√‘°“√∫“ߪ√–‡¿∑ ´÷ËßÕ“®

‡ªìπ∫√‘°“√∑’Ë¡’§«“¡´—∫´âÕπÀ√◊Õ¡’§à“„™â®à“¬ Ÿß ª√–‡∑»

‡¬Õ√¡π’„™â«‘∏’π’ȇπ◊ËÕß®“°‰¡à¡’¢âÕ¡Ÿ≈∑’ˇ撬ßæÕ„π°“√§”π«≥

À“μâπ∑ÿπ¢Õß DRG Õ’°∑—Èß¡’¢âÕ®”°—¥∫“ߪ√–°“√‡°’ˬ«°—∫

¢âÕ¡Ÿ≈°“√∂à«ßπÈ”Àπ—°μâπ∑ÿπ¢Õß DRG π—Èπ(20)

2.3 Õ—μ√“®à“¬™¥‡™¬Õ—μ√“‡¥’¬«À√◊ÕÀ≈“¬Õ—μ√“

·μà≈–ª√–‡∑»¡’·π«§‘¥°“√°”Àπ¥Õ—μ√“®à“¬·μ°

μà“ß°—π ·≈–¡’°ÆÀ¡“¬∫—ߧ—∫„™â·μ°μà“ß°—π ∫“ߪ√–‡∑»

°”Àπ¥Õ—μ√“®à“¬Õ—μ√“‡¥’¬«(12) ‡™àπ ª√–‡∑»‡Õ ‚∑‡π’¬‰¥â

°”Àπ¥„ÀâÕ—μ√“®à“¬μâÕ߇∑à“°—π„π∑ÿ°Àπ૬∫√‘°“√ ‡æ√“–‰¡à¡’

‡Àμÿº≈ π—∫ πÿπ‡æ’¬ßæÕ«à“∑”‰¡°“√√—°…“„π‚√ß欓∫“≈

¢π“¥„À≠àÀ√◊Õ‚√ß欓∫“≈∑’Ë¡’»—°¬¿“æ ŸßμâÕß·æß°«à“‚√ß

欓∫“≈∑—Ë«‰ª ‡™àπ °√≥’°“√√—°…“‚√§‰ âμ‘ËßÕ—°‡ ∫∏√√¡¥“

À√◊Õ°“√√—°…“‚√§μàÕ¡∑Õ≈´‘πÕ—°‡ ∫∏√√¡¥“ ¢≥–∑’ËÀ“°‚√ß

欓∫“≈¢π“¥„À≠à®–√—°…“‚√§∑’Ë¡’§«“¡´—∫´âÕπ¡“°°«à“°Á¡’

°“√„™âμ√√°–π’È„π°“√®—¥°≈ÿà¡ DRG Õ¬Ÿà·≈â« Õ¬à“߉√°Áμ“¡ ¡’

¢âÕ∂°‡∂’¬ßÕ¬à“ß¡“°„π°≈ÿà¡π—°«‘™“°“√«à“§à“πÈ”Àπ—° DRG

Õ“®°”Àπ¥„Àâ‡À¡◊Õπ°—π ·μàÕ—μ√“®à“¬·μ°μà“ß°—π‰¥â ∑—Èßπ’È

‡æ◊ËÕ‡æ‘Ë¡·√ß®Ÿß„®·°à‚√ß欓∫“≈»Ÿπ¬å·≈–‚√ß欓∫“≈‡¢μ„Àâ

‡¢â“ Ÿà√–∫∫°“√‡∫‘°®à“¬·∫∫ DRG ·μà∑⓬∑’Ë ÿ¥‡¡◊ËÕæ‘®“√≥“

Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

5

 —¥ à«π¢Õß‚√ß欓∫“≈¢π“¥‡≈Á°μàÕ‚√ß欓∫“≈¢π“¥„À≠à

 ¡“§¡‚√ß欓∫“≈®÷ßμ—¥ ‘π™’È¢“¥„Àâ„™âÕ—μ√“®à“¬‡¥’¬«∑—Èß

ª√–‡∑» ‡π◊ËÕß®“°‚√ß欓∫“≈ à«π„À≠à„πª√–‡∑»‡Õ ‚∑‡π’¬

‡ªìπ‚√ß欓∫“≈¢π“¥‡≈Á°(21)

∫“ߪ√–‡∑»¡’°“√°”Àπ¥Õ—μ√“®à“¬À≈“¬Õ—μ√“ ‡π◊ËÕß®“°

 ∂“π∑’Ëμ—Èß‚√ß欓∫“≈¡’ à«π∑”„Àâμâπ∑ÿπ¢Õß‚√ß欓∫“≈μà“ß

°—π(12) ‡™àπ „πª√–‡∑» À√—∞Õ‡¡√‘°“ Medicare „™âÕ—μ√“®à“¬

 Õß·∫∫§◊Õ Õ—μ√“®à“¬ ”À√—∫‚√ß欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„π‡¢μ‡¡◊Õß

¢π“¥„À≠à∑’Ë¡’ª√–™“°√‡∑à“°—∫À√◊Õ¡“°°«à“Àπ÷Ëß≈â“π§π ·≈–

Õ—μ√“®à“¬ ”À√—∫‚√ß欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„π‡¢μ‡¡◊Õß∑’˪√–™“°√

πâÕ¬°«à“Àπ÷Ëß≈â“π§π·≈–‡¢μ™π∫∑ ‚¥¬°”Àπ¥Õ—μ√“®à“¬°àÕπ

®–π”μ—«ª√–°Õ∫ª√—∫§à“Õ◊ËπÊ ¡“«‘‡§√“–Àå‡æ‘Ë¡‡μ‘¡ ‡™àπ„πªï §.».

2002 ¡’°“√°”Àπ¥Õ—μ√“®à“¬μàÕ°“√®”Àπà“¬ºŸâªÉ«¬∑’Ë 4,157

¥Õ≈≈“√å ”À√—∫‚√ß欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„π‡¢μ‡¡◊Õß¢π“¥„À≠à

·≈–Õ—μ√“®à“¬ 4,091 ¥Õ≈≈“√å ”À√—∫‚√ß欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„πæ◊Èπ∑’Ë

Õ◊ËπÊ(22)

πÕ°®“°π’È ¬—ß¡’°“√π”ªí®®—¬μ—«ª√–°Õ∫ª√—∫§à“μà“ßÊ ∑’Ë

Õ“® –∑âÕπμâπ∑ÿπ¢Õß‚√ß欓∫“≈‰¥â≈–‡Õ’¬¥¬‘Ëߢ÷Èπ¡“§”π«≥

Õ—μ√“®à“¬√à«¡¥â«¬ ∑—Èßπ’È¢÷ÈπÕ¬Ÿà°—∫À≈—°°“√§‘¥¢Õߪ√–‡∑»π—ÈπÊ

·μà∫∑§«“¡π’È¢Õπ”À≈—°§‘¥¢Õß°“√π”ªí®®—¬μ—«ª√–°Õ∫ª√—∫

§à“¢Õߪ√–‡∑» À√—∞Õ‡¡√‘°“¡“‡ªìπμ—«Õ¬à“ß ‡æ√“–‡ªìπ

ª√–‡∑»·√°∑’Ëæ—≤π“√–∫∫ DRG ¢âÕ¡Ÿ≈π’ȉ¥â®“° Report to

the Congress ‡√◊ËÕß Medicare Payment Policy(22)  √ÿª‰¥â

¥—ßπ’È

1) ¥—™π’§à“®â“ß (Application of a Wage Index)

§à“®â“ß∫ÿ§≈“°√§◊Õ§à“„™â®à“¬∑’ˇªìπÕߧåª√–°Õ∫„À≠à

¢Õß§à“„™â®à“¬‚√ß欓∫“≈ Õ—μ√“§à“®â“ß¡’§«“¡·μ°μà“ß°—π

√–À«à“ßæ◊Èπ∑’Ë °“√„™âÕ—μ√“®à“¬ DRG ‡ªìπÕ—μ√“‡¥’¬«°—π ”À√—∫

∑ÿ°‚√ß欓∫“≈Õ“®π”‰ª Ÿà§«“¡‰¡à‡ªìπ∏√√¡ ”À√—∫‚√ß

欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„πæ◊Èπ∑’Ë∑’Ë¡’Õ—μ√“§à“®â“ß Ÿß Centers for Medi-

care & Medicaid Services (CMS) „π À√—∞Õ‡¡√‘°“‰¥â

ª√—∫Õ—μ√“®à“¬°≈“ß (Federal DRG rates) ‡æ◊ËÕ –∑âÕ𧫓¡

·μ°μà“ߢÕßÕ—μ√“§à“®â“ߢÕß∫ÿ§≈“°√μ“¡æ◊Èπ∑’Ë ‚¥¬°”Àπ¥

Õ—μ√“§à“®â“ß∫ÿ§≈“°√∑’Ë —¡æ—π∏å°—∫Õ—μ√“§à“®â“ߢÕßæ◊Èπ∑’Ë  àߺ≈

„Àâ‚√ß欓∫“≈„πæ◊Èπ∑’Ë∑’Ë¡’Õ—μ√“§à“®â“ß Ÿß‰¥â√—∫°“√®à“¬¿“¬„μâ

√–∫∫ DRG  Ÿß°«à“‚√ß欓∫“≈∑’Ëμ—ÈßÕ¬Ÿà„πæ◊Èπ∑’Ë∑’Ë¡’Õ—μ√“§à“®â“ßμË”

2) §à“„™â®à“¬®“°°“√‡√’¬π°“√ Õπ∑“ß°“√·æ∑¬å (In-

direct Medical Education Cost)

‡π◊ËÕß®“° ∂“∫—π°“√·æ∑¬å ‡™àπ ‚√߇√’¬π·æ∑¬å

πÕ°®“°¡’¿“√°‘®¥â“π°“√‡√’¬π°“√ Õπ·≈â« ¬—ßμâÕß„Àâ∫√‘°“√

·°àºŸâªÉ«¬ ´÷Ëß‚¥¬¡“°‡ªìπºŸâªÉ«¬Àπ—°À√◊Õ√⓬·√ß ‡Àμÿº≈¥—ß

°≈à“«π”‰ª Ÿà ¡¡μ‘∞“π‡√◊ËÕß§à“„™â®à“¬¢Õß‚√߇√’¬π·æ∑¬å∑’Ë Ÿß

°«à“ª°μ‘ ‚√ß欓∫“≈ª√–‡¿∑π’È®÷ߧ«√‰¥â√—∫°“√®à“¬‡ß‘π¿“¬

„μâ√–∫∫ DRG ∑’Ëμà“ßÕÕ°‰ª‚¥¬æ‘®“√≥“®“°Õ—μ√“ à«π¢Õß

·æ∑¬åΩñ°À—¥·≈–ª√–™“°√„πæ◊Èπ∑’ËμàÕ®”π«π‡μ’¬ß

3) §à“∫√‘°“√ ”À√—∫ºŸâªÉ«¬°≈ÿà¡μ°‡°≥±å (Cost Out-

lier)

„πª√–‡∑» À√—∞Õ‡¡√‘°“ √–∫∫ª√–°—π ÿ¢¿“æ Medi-

care ‰¥â®à“¬‡æ‘Ë¡‡μ‘¡·°à‚√ß欓∫“≈ ”À√—∫ºŸâªÉ«¬∫“ß√“¬∑’Ë¡’

§à“„™â®à“¬‚¥¬√«¡ Ÿß°«à“ª°μ‘ ´÷Ëß„π°√≥’π’ȇ√’¬°«à“ çcost

outliersé ‚¥¬ CMS ‡ªìπºŸâ°”Àπ¥‡æ¥“π§à“„™â®à“¬ ”À√—∫

°√≥’§à“„™â®à“¬ Ÿßº‘¥ª°μ‘‡ªìπ√“¬ªï À“°ºŸâªÉ«¬√“¬„¥¡’§à“„™â

®à“¬‡°‘πÕ—μ√“∑’Ë°”Àπ¥ ‚√ß欓∫“≈®–‰¥â√—∫°“√™”√–‡ß‘π·∫∫

çcost outlieré Õ¬à“߉√°Áμ“¡ √–∫∫°“√®à“¬‡ß‘π·°à‚√ß

欓∫“≈„π°√≥’§à“„™â®à“¬„π°“√√—°…“ Ÿß°«à“ª°μ‘‰¡à‰¥â‡ªìπ

√–∫∫Õ—μ‚π¡—쑇À¡◊Õπ°√≥’Õ◊ËπÊ ‚√ß欓∫“≈μâÕß®—¥∑”

√“¬ß“πμâπ∑ÿπ°“√√—°…“ºŸâªÉ«¬‡æ◊ËÕ‡√’¬°‡°Á∫‡ß‘π®“° Medicare

4) °“√®à“¬μ“¡ —¥ à«π°“√„Àâ∫√‘°“√ (Dispropor-

tionate Share Payment)

„π À√—∞Õ‡¡√‘°“  —¥ à«π°“√„Àâ∫√‘°“√ ”À√—∫°≈ÿà¡

ºŸâªÉ«¬∑’Ë¡’√“¬‰¥âπâÕ¬ (low income patients) √«¡∂÷ߺŸâ

ª√–°—πμπ¿“¬„μâ ‘∑∏‘ Medicaid ·≈– Medicare ¢Õß‚√ß

欓∫“≈·μ°μà“ß°—π ∫“ß‚√ß欓∫“≈¡’ —¥ à«π°“√„Àâ∫√‘°“√

 ”À√—∫ºŸâªÉ«¬°≈ÿà¡¥—ß°≈à“«„πÕ—μ√“ à«π∑’Ë Ÿß (disproportionate

share hospitals) ´÷Ëß CMS ‰¥âæ‘®“√≥“‡æ‘Ë¡Õ—μ√“®à“¬„Àâ°—∫

‚√ß欓∫“≈°≈ÿà¡π’È

5) °“√®à“¬„Àâ°—∫Àπ૬∫√‘°“√∑’Ë√—∫ àßμàÕ (Transfer

payment)

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

6

„π√—∞·§≈‘øÕ‡π’¬ ª√–‡∑» À√—∞Õ¡√‘°“ ¡’°“√ª√—∫Õ—μ√“

°“√®à“¬‡ß‘π·°à‚√ß欓∫“≈∑’Ë√—∫ àßμàÕºŸâªÉ«¬„π®“°‚√ß欓∫“≈

Õ◊Ëπ ‚√ß欓∫“≈∑’Ë√—∫ àßμàÕºŸâªÉ«¬®–‰¥â√—∫°“√®à“¬™¥‡™¬‡¡◊ËÕ

∑”°“√√—°…“ºŸâªÉ«¬‚¥¬¡‘‰¥â àßμàÕºŸâªÉ«¬‰ª¬—ß‚√ß欓∫“≈Õ◊ËπÕ’°

°“√°”Àπ¥Õ—μ√“®à“¬ ”À√—∫‚√ß欓∫“≈∑’Ë√—∫ àßμàÕ§‘¥®“°°“√

·∫àß à«πÕ—μ√“®à“¬ DRG (prorated DRG base payment)

Õ—μ√“®à“¬∑’Ë¡’°“√·∫àß à«π¢÷Èπ°—∫®”π«π«—π∑’˺ŸâªÉ«¬‡¢â“√—∫°“√

√—°…“∑’Ë‚√ß欓∫“≈∑’Ë√—∫ àßμàÕ À“√¥â«¬®”π«π«—π‡©≈’ˬ∑’˺ŸâªÉ«¬

„π°≈ÿà¡ DRG ‡¥’¬«°—ππÕπ√—°…“„π‚√ß欓∫“≈∑’ˉ¡à‰¥â àßμàÕ

ºŸâªÉ«¬‰ª¬—ß‚√ß欓∫“≈Õ◊Ëπ

3. °“√π”√–∫∫ DRG ¡“„™â„π°“√®à“¬§à“∫√‘°“√ºŸâªÉ«¬

„π¢Õߪ√–‡∑»‰∑¬

√–∫∫ DRG ¡’°“√æ—≤π“„πª√–‡∑»‰∑¬‡ªìπ√–¬–‡«≈“

‡°◊Õ∫ 20 ªï ‚¥¬‡√‘Ë¡§√—Èß·√°„πªï æ.». 2536  ”À√—∫ºŸâªÉ«¬

Õÿ∫—쑇Àμÿ(23) ‡æ◊ËÕ√Õß√—∫æ√–√“™∫—≠≠—쑧ÿ⡧√ÕߺŸâª√– ∫¿—¬

®“°√∂¬πμå ·μà‰¡à¡’°“√π”¡“„™â μàÕ¡“®÷ßæ—≤π“°“√®—¥°≈ÿà¡

‚√§ºŸâªÉ«¬„π∑ÿ°√“¬‚¥¬„™â∞“π¢âÕ¡Ÿ≈ºŸâªÉ«¬„π(24,25) ·≈–

ª√–°“»„™â„π√–∫∫°“√§≈—ß ÿ¢¿“æ‡æ◊ËÕ®à“¬‡ß‘π§à“√—°…“

欓∫“≈ºŸâªÉ«¬„π °√≥’§à“√—°…“√“§“ Ÿß„π‚§√ß°“√∫—μ√

ª√–°—π ÿ¢¿“æ (∫—μ√ 500 ∫“∑) °“√π”√–∫∫°“√®à“¬§à“√—°…“

欓∫“≈·∫∫ DRG „πªï æ.». 2542 ´÷Ëß∂◊Õ‡ªìπ DRG ©∫—∫∑’Ë

1 ‰¥â∑”„À⇰‘¥°“√μ◊Ëπμ—«¥â“π¢âÕ¡Ÿ≈°“√„Àâ∫√‘°“√ºŸâªÉ«¬„π√“¬

∫ÿ§§≈‡ªìπÕ¬à“ß Ÿß(26)

°“√‡∫‘°®à“¬¥â«¬√–∫∫ DRG ¢Õߪ√–‡∑»‰∑¬¡’

æ—≤π“°“√∑’ˬ“«π“π·≈–¡’°“√ª√—∫ª√ÿ߇ª≈’ˬπ·ª≈ßÀ≈“¬§√—Èß

À≈—°ª√–°—π ÿ¢¿“æ·μà≈–ª√–‡¿∑‰¡à‰¥â‡√‘Ë¡„™â√–∫∫ DRG „π

™à«ß‡«≈“‡¥’¬«°—π √“¬≈–‡Õ’¬¥‡°’ˬ«°—∫«‘«—≤π“°“√√–∫∫ DRG

¢Õߪ√–‡∑»‰∑¬ °“√π”√–∫∫ DRG ‰ª„™â„π√–∫∫À≈—°

ª√–°—π ÿ¢¿“æ ·≈–ªí≠À“∑’Ëæ∫  √ÿª‰¥â¥—ßπ’È

3.1 «‘«—≤π“°“√√–∫∫ DRG ¢Õߪ√–‡∑»‰∑¬

√Ÿª∑’Ë 1 · ¥ß«‘«—≤π“°“√√–∫∫ DRG ¢Õ߉∑¬ DRG

©∫—∫∑’Ë 1 ¡’°≈ÿà¡ DRG ‡æ’¬ß 511 °≈ÿà¡ DRG ©∫—∫∑’Ë 5 ¡’°≈ÿà¡

√Ÿª∑’Ë 1 «‘«—≤π“°“√√–∫∫ DRG ¢Õߪ√–‡∑»‰∑¬

∑’Ë¡“: ª√—∫®“° ‰™¬¬» ª√– “π«ß»å(27)

Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

7

DRG ‡æ‘Ë¡‡ªìπ 2,540 °≈ÿà¡ ®”π«π°≈ÿà¡∑’ˇæ‘Ë¡¢÷ÈπÕ¬Ÿà°—∫√–∫∫

¢âÕ¡Ÿ≈·≈–§«“¡§√Õ∫§≈ÿ¡¢Õß√À— ‚√§ DRG ©∫—∫∑’Ë 1 ‡√‘Ë¡

„™â‡©æ“–°≈ÿࡺŸâªÉ«¬∑’Ë¡’§à“√—°…“ Ÿß √À— ‚√§®÷߉¡à§√Õ∫§≈ÿ¡

√À— ‚√§μà“ßÊ Õ¬à“ߧ√∫∂â«π ‚ª√·°√¡®—¥°≈ÿà¡«‘π‘®©—¬‚√§

√à«¡¢Õ߉∑¬ (Thai DRG Grouper) ‡¡◊ËÕ‡∑’¬∫°—∫‚ª√·°√¡

Wales AP-Grouper ®÷߬—ߧߡ’§«“¡¥âÕ¬°«à“ ‚¥¬¡’°≈ÿà¡ DRG

465, 470, ·≈– 477  ”À√—∫‚√§∑’Ë®—∫‡¢â“°≈ÿࡉ¡à‰¥â (ungroupable

DRG) ¡“°°«à“ ¢≥–∑’˧–·πππÈ”Àπ—° —¡æ—∑∏剡ࠖ∑âÕπ°“√

„™â∑√—欓°√„π°“√√—°…“ºŸâªÉ«¬√–¥—∫μà“ßÊ(28)

‡¡◊ËÕ§ÿ≥¿“æ¢ÕߢâÕ¡Ÿ≈¥’¢÷Èπ‡ªìπ≈”¥—∫®÷ßæ—≤𓂪√·°√¡

DRG grouper version II ´÷Ëß¡’«—μ∂ÿª√– ß§å‡æ◊ËÕ≈¥º≈≈—æ∏å

¢Õß°“√‰¥â°≈ÿà¡ ungroupable DRG ‚¥¬¬—ߧßÕâ“ßÕ‘ß«‘∏’®—¥°≈ÿà¡

DRG ∑’Ë„™â„π√–∫∫ª√–°—π ÿ¢¿“æ·∫∫ Medicare ·≈–¡’°“√

∑¥≈Õß„™â Swiss-AP Grouper ‡æ◊ËÕπ”¡“‡ª√’¬∫‡∑’¬∫°—∫ Thai

DRG Grouper version II ∑—Èß Õß‚ª√·°√¡„Àâº≈°“√«‘‡§√“–Àå

∑’Ëμ√ß°—π Ÿß¢÷Èπ Õ¬à“߉√°Áμ“¡®”π«π°≈ÿà¡ DRG ¬—ߧ߇ªìπ 511

°≈ÿࡇ∑à“‡¥‘¡(25) ·≈–‡π◊ËÕß®“°°“√®—¥°≈ÿà¡ DRG Õâ“ßÕ‘ß√–∫∫

¢Õß À√—∞Õ‡¡√‘°“ ∑—Èß DRG ©∫—∫∑’Ë 1 ·≈– 2 ®÷ß¡’ªí≠À“

À√◊Õ¢âÕ®”°—¥‡À¡◊ÕπÊ °—π §◊Õ ‰¡à¡’§«“¡≈–‡Õ’¬¥‡æ’¬ßæÕ∑’Ë

®–𔉪ª√—∫„™â„π°“√®—¥°≈ÿà¡‚√§‡¥Á°·≈–°≈ÿà¡‚√§∑’Ëæ∫„π

‡¢μ√âÕπ(29)

DRG ©∫—∫∑’Ë 3 æ—≤π“‚¥¬Õâ“ßÕ‘ß·π«§‘¥ Australian Re-

fined DRG ¡’°“√æ—≤π“°“√®—¥°≈ÿà¡‚√§∑’˧√Õ∫§≈ÿ¡°≈ÿà¡

‚√§‡¥Á°‰¥â≈–‡Õ’¬¥¢÷Èπ ¡’°“√·¬°°≈ÿà¡‚√§‡¢μ√âÕπ∑’Ë –∑âÕπ

·∫∫·ºπ°“√√—°…“∑’Ë¡’μâπ∑ÿπ·μ°μà“ß°—π ·≈–¡’°“√·¬°√–¥—∫

§«“¡√ÿπ·√ß (complication and comorbidity level, CC

level) ¢Õß‚√§¥â«¬ ‚¥¬‚√§∑’Ë¡’√–¥—∫§«“¡√ÿπ·√ß Ÿß¡’§«“¡

¬ÿà߬“°„π°“√√—°…“¡“°¢÷Èπ ·≈–„™â∑√—欓°√„π°“√√—°…“¡“°¢÷Èπ

πÕ°®“°π’Ȭ—ß¡’°“√°”Àπ¥Õ“¬ÿ ‡æ» ∑’Ë —¡æ—π∏å°—∫‚√§·≈–°“√

ºà“μ—¥ Õ’°∑—È߬—ß¡’°“√°”Àπ¥√À— ‚√§∑’ˉ¡à ¡§«√‡ªìπ‚√§À≈—°

μ√√°–∑’Ë„™â„π°“√®—¥°≈ÿà¡®÷ß¡’§«“¡≈–‡Õ’¬¥¬‘Ëߢ÷Èπ DRG ©∫—∫

∑’Ë 3 ¡’°≈ÿà¡ DRG 1,283 °≈ÿà¡ «—μ∂ÿª√– ß§åÀ≈—° §◊Õ °“√®—¥

°≈ÿà¡‚√§„À¡à (reclassification) ·≈–ª√—∫§à“πÈ”Àπ—° —¡æ—∑∏å„À¡à

(recalibration) ‡æ◊ËÕ –∑âÕπ°“√„™â∑√—欓°√„π°“√√—°…“ºŸâªÉ«¬

„π√–¥—∫μà“ßÊ(29)

DRG ©∫—∫∑’Ë 4 ¡’°≈ÿà¡ DRG 1,920 °≈ÿà¡ ≈—°…≥–‡¥àπ

§◊Õ ·¬°§«“¡·μ°μà“ߢÕß°“√ºà“μ—¥À√◊Õ∑”À—μ∂°“√„π

Õ«—¬«–∑’Ë¡’ 2 ¢â“ß °“√ºà“μ—¥À≈“¬§√—Èß∑’ËÕ«—¬«–‡¥‘¡„π°“√πÕπ

√—°…“„π‚√ß欓∫“≈§√—È߇¥’¬« ¡’°“√‡æ‘Ë¡§«“¡‡¢â¡ß«¥¢Õß

¢âÕ¡Ÿ≈°“√®—¥°≈ÿà¡ DRG ∑’Ë¡’§à“πÈ”Àπ—° —¡æ—∑∏å Ÿß ‡™àπ °“√

ºà“μ—¥≈‘ÈπÀ—«„®À≈“¬μ”·Àπàß °“√¥Ÿ·≈ºŸâªÉ«¬‡®“–§Õ À√◊Õ°“√

ºà“μ—¥¢âÕ°√–¥Ÿ°¢“ Õߢâ“ßÀ√◊Õºà“μ—¥„À≠àÀ≈“¬¢âÕ ‡ªìπμâπ ¡’

°“√·¬°§à“Õÿª°√≥å°“√·æ∑¬å√“§“ Ÿß®“°§à“πÈ”Àπ—° —¡æ—∑∏å

·≈–®—¥√–¥—∫§«“¡¬“°ßà“¬¢Õß√À— À—μ∂°“√‡æ◊ËÕ≈¥‚Õ°“ ‡°‘¥

°≈ÿà¡∑’ˉ¡à¡’§«“¡À¡“¬(30,31) °“√∑’Ë DRG ©∫—∫∑’Ë 4 ¡’®”π«π

°≈ÿࡇæ‘Ë¡¢÷Èπ  à«πÀπ÷Ëß¡“®“°°“√ª√—∫‡ª≈’ˬπ«‘∏’°“√√—°…“¡–‡√Áß

°“√‡æ‘Ë¡√À— ‚√§ ICD-10 ªï §.». 2006 ·≈–°“√‡æ‘Ë¡√À— 

À—μ∂°“√ ICD-9 ªï §.». 2007(32)

·¡â‡ªì𧫓¡æ¬“¬“¡®—¥°≈ÿࡇæ◊ËÕ –∑âÕ𧫓¡¬“°ßà“¬

·≈–°“√„™â∑√—欓°√∑’Ë¥’¢÷Èπ DRG ©∫—∫∑’Ë 4 ¬—ß∂Ÿ°«‘æ“°…å

Õ¬à“ß¡“°«à“ ‡ªìπ°“√·¬°°≈ÿà¡‚√§‡æ◊ËÕ‡Õ◊ÈÕª√–‚¬™πå·°à‚√ß

欓∫“≈¢π“¥„À≠à·≈–‚√ß欓∫“≈μ쑬¿Ÿ¡‘ ´÷Ëß¡’ºŸâªÉ«¬∑’Ë¡’

¿“«–·∑√°´âÕπ Ÿß·≈–¥÷ß‡ß‘π‰ª‰¥â¡“° ‚¥¬¡’¢âÕ —߇°μ§◊Õ

‡¡◊ËÕ¡’°“√„™â DRG ©∫—∫∑’Ë 4 ·∑π©∫—∫∑’Ë 3 §à“‡©≈’ˬ§–·ππ

 —¡æ—∑∏å°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (CMI) ¡’·π«‚π⡇æ‘Ë¡¢÷ÈπμàÕ‡π◊ËÕß

(√Ÿª∑’Ë 2) ·≈–‡æ‘Ë¡¢÷Èπ§àÕπ¢â“ß¡“°„π°≈ÿà¡‚√ß欓∫“≈‡°◊Õ∫∑ÿ°

ª√–‡¿∑ ¬°‡«âπ‚√ß欓∫“≈™ÿ¡™π„πªï 2551 ´÷Ëß à«πÀπ÷Ëß¡’

 “‡Àμÿ®“°»—°¬¿“æ„π°“√„Àâ√À—  ICD-10 ·≈– ICD-9-CM(33)

´÷Ëß®–‰¥â°≈à“«„π≈”¥—∫∂—¥‰ª

·¡â DRG ©∫—∫∑’Ë 4 ¡’®”π«π°≈ÿà¡¡“°∂÷ß 1,920 À“°°Á¬—ß

æ∫§«“¡®”‡ªìπ„π°“√·°âªí≠À“°“√®—¥°≈ÿà¡ (reclassification)

∑’ˉ¡à‡À¡“– ¡·≈–¡’§à“πÈ”Àπ—° —¡æ—∑∏剡à Õ¥§≈âÕß°—∫§à“„™â®à“¬

DRG ©∫—∫∑’Ë 5 ®÷ß∂Ÿ°æ—≤π“‡æ◊ËÕ·°â‰¢ªí≠À“¥—ß°≈à“« ‚¥¬¡’

°“√ª√—∫§à“πÈ”Àπ—° —¡æ—∑∏å°√≥’«—ππÕπ —Èπ·≈–«—ππÕππ“π

‡°‘π‡°≥±å ‡æ◊ËÕ –∑âÕπμâπ∑ÿπ∫√‘°“√¢ÕßÀπ૬∫√‘°“√ √«¡∂÷ß

æ—≤π“°≈ÿà¡ DRG „Àâ¡’§«“¡§√Õ∫§≈ÿ¡ºŸâªÉ«¬„π∑ÿ°√–¬– ∑—Èß

√–¬–‡©’¬∫æ≈—π °÷Ë߇©’¬∫æ≈—π ·≈–‰¡à‡©’¬∫æ≈—π(34) ‚¥¬

°√–∑√«ß°“√§≈—߉¥âª√–°“»„™â DRG ©∫—∫∑’Ë 5 ´÷Ë߇√‘Ë¡∫—ߧ—∫

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

8

„™â°—∫ºŸâªÉ«¬„π∑’ˉ¥â®”Àπà“¬ÕÕ°®“° ∂“π欓∫“≈μ—Èß·μà«—π∑’Ë 1

‡¡…“¬π 2555(35) ¡’®”π«π°≈ÿà¡ DRG 2,540 °≈ÿà¡

3.2 °“√π”√–∫∫ DRG ¡“„™â„π°“√®à“¬§à“√—°…“

欓∫“≈„π√–∫∫ª√–°—π ÿ¢¿“æ‰∑¬

3.2.1 °“√π”¡“„™â„π√–∫∫À≈—°ª√–°—π ÿ¢¿“æ

·Ààß™“μ‘

°“√π”√–∫∫ DRG ¡“„™â„π√–∫∫À≈—°ª√–°—π

 ÿ¢¿“æ·Ààß™“μ‘ ‡ªìπ°“√®à“¬∑’˧”π«≥Õ—μ√“®à“¬¿“¬„μâ«ß‡ß‘π

∑’Ë¡’Õ¬Ÿà (DRGs with global budget) ‚¥¬ªí®®ÿ∫—π°”Àπ¥

Õ—μ√“®à“¬™¥‡™¬ (base rate) μàÕπÈ”Àπ—° —¡æ—∑∏å∑’˪√—∫¥â«¬

«—ππÕπ (adjusted relative weight: adjRW) „πÕ—μ√“

§ß∑’Ë ”À√—∫‚√ß欓∫“≈∑ÿ°ª√–‡¿∑ Õ¬à“߉√°Á¥’ „π™à«ß∑’˺à“π¡“

¡’°“√°”Àπ¥ base rate μà“ß°—π ”À√—∫‚√ß欓∫“≈·μà≈–

ª√–‡¿∑ ‡™àπ „πªïß∫ª√–¡“≥ 2547 °”Àπ¥ base rate ‡ªìπ

 “¡Õ—μ√“ §◊Õ 10,000, 14,000 ·≈– 16,000 ∫“∑μàÕ adjRW

 ”À√—∫‚√ß欓∫“≈·μà≈–√–¥—∫ μàÕ¡“‰¥â¡’°“√¬°‡≈‘°‡æ◊ËÕ„™â

‡ªìπÕ—μ√“‡¥’¬«°—π„πªï 2548 §√—ÈπμàÕ¡“„πªïß∫ª√–¡“≥

2551(36,37) ‡¡◊ËÕ¡’°“√„™â DRG ©∫—∫∑’Ë 4 °Á¡’°“√ª√—∫πÈ”Àπ—°

 —¡æ—∑∏å°≈ÿà¡«‘π‘®©—¬‚√§√à«¡¢Õß‚√ß欓∫“≈™ÿ¡™π‡æ‘Ë¡‡ªìπ 1.32

‡∑à“‡æ◊ËÕ≈¥º≈°√–∑∫¢Õß°“√π” DRG ©∫—∫∑’Ë 4 ¡“„™â(38)

 ”À√—∫ªïß∫ª√–¡“≥ 2556 Õ—μ√“°“√®à“¬™¥‡™¬μàÕπÈ”

Àπ—° —¡æ—∑∏å∑’˪√—∫§à“‰¥â·∫àßÕÕ°‡ªìπ 4 ª√–‡¿∑ §◊Õ °“√„™â

∫√‘°“√πÕ°‡¢μ °“√„™â∫√‘°“√°√≥’ ”√Õß‡μ’¬ß °“√„™â∫√‘°“√

°√≥’¡“μ√“ 7 ·≈–°“√„™â∫√‘°“√¿“¬„π‡¢μ °“√„™â∫√‘°“√πÕ°

‡¢μ  ª ™. °”Àπ¥Õ—μ√“®à“¬™¥‡™¬∑’Ë 9,000 ∫“∑μàÕ 1 adjRW

„πªïß∫ª√–¡“≥ 2555 ·≈–ª√—∫‡æ‘Ë¡‡ªìπ 9,600 ∫“∑μàÕ 1

adjRW „πªïß∫ª√–¡“≥ 2556  ”À√—∫Àπ૬∫√‘°“√∑ÿ°√–¥—∫

·≈–‰¡àª√—∫≈¥§à“·√ß ”À√—∫Àπ૬∫√‘°“√¿“§√—∞·≈–‚√ß

欓∫“≈ —ß°—¥ ”π—°ª≈—¥°√–∑√«ß “∏“√≥ ÿ¢ °√≥’æ◊Èπ∑’Ë√Õ¬

μàÕ„Àâ°”Àπ¥Õ—μ√“®à“¬μ“¡¢âÕμ°≈ß√–À«à“ßÀπ૬∫√‘°“√ ·μà

μâÕ߉¡à‡°‘π 9,600 ∫“∑ μàÕ 1 adjRW

°“√„™â∫√‘°“√°√≥’ ”√Õß‡μ’¬ß  ª ™. ‰¥â°”Àπ¥„À⇪ìπ

‰ªμ“¡Õ—μ√“∑’ˇÀÁπ™Õ∫√à«¡°—π√–À«à“ßÀπ૬∫√‘°“√°—∫  ª ™.

‡¢μ·μà≈–‡¢μ ‚¥¬Àπ૬∫√‘°“√∑’Ë„Àâ∫√‘°“√ ‘∑∏‘«à“ß ´÷ËßÀπ૬

∫√‘°“√§Ÿà —≠≠“À√◊Õ„π√–∫∫‰¡à “¡“√∂„Àâ∫√‘°“√‰¥â ‡™àπ °√≥’

ºŸâªÉ«¬μâÕ߉¥â√—∫°“√ºà“μ—¥ ¡Õß ‡¥Á°·√°‡°‘¥∑’Ë¡’π”Àπ—°μ—«

πâÕ¬°«à“ 1,500 °√—¡ ‡ªìπμâπ ®–‰¥â√—∫Õ—μ√“®à“¬„πÕ—μ√“§ß∑’Ë

μ“¡ —≠≠“°“√„Àâ∫√‘°“√‰¡à‡°‘π 15,000 ∫“∑ μàÕ 1 adjRW ·≈–

 ª ™. ®–§”π«≥Õ—μ√“®à“¬·°àÀπ૬∫√‘°“√‡ªìπ√“¬‡¥◊Õπ(39,40)

°“√„™â∫√‘°“√°√≥’¡“μ√“ 7 (∑—ÈßÀπ૬∫√‘°“√„π√–∫∫·≈–

√Ÿª∑’Ë 2 §à“‡©≈’ˬ§–·ππ —¡æ—∑∏å°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (CMI) ®”·π°μ“¡°≈ÿà¡‚√ß欓∫“≈ ªï æ.». 2548 - 2553

∑’Ë¡“:  —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï ·≈–§≥–(33)

Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

9

πÕ°√–∫∫) „À⇪ìπ‰ªμ“¡∑’Ë√–∫ÿ„π æ√–√“™∫—≠≠—μ‘À≈—°

ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ æ.». 2545 À¡«¥ 1 «à“¥â«¬ ‘∑∏‘°“√

√—∫∫√‘°“√ “∏“√≥ ÿ¢¡“μ√“ 7 ‚¥¬∫ÿ§§≈¡’ ‘∑∏‘‡¢â“√—∫∫√‘°“√

®“° ∂“π∫√‘°“√Õ◊Ëπ‰¥â ∑—Èßπ’Èμ“¡∑’˧≥–°√√¡°“√°”Àπ¥ ‚¥¬

§”π÷ß∂÷ߧ«“¡ –¥«°·≈–§«“¡®”‡ªìπ¢Õß°“√„™â ‘∑∏‘√—∫∫√‘°“√

 ∂“π∫√‘°“√∑’Ë„Àâ∫√‘°“√¡’ ‘∑∏‘‰¥â√—∫§à“„™â®à“¬®“°°Õß∑ÿπμ“¡

À≈—°‡°≥±å «‘∏’°“√ ·≈–‡ß◊ËÕπ‰¢∑’˧≥–°√√¡°“√°”Àπ¥ ‚¥¬

·∫àߪ√–‡¿∑Õ—μ√“®à“¬ ¥—ßπ’È 1) §à“√—°…“欓∫“≈ ®à“¬μ“¡®√‘ß

·μà‰¡à‡°‘π√“¬≈– 4,500 ∫“∑ 2) °√≥’ºà“μ—¥„À≠à „™â‡«≈“‰¡à‡°‘π

2 ™—Ë«‚¡ß ®à“¬μ“¡®√‘ß·μà‰¡à‡°‘π√“¬≈– 8,000 ∫“∑ 3) °√≥’

ºà“μ—¥„À≠à „™â‡«≈“‡°‘π 2 ™—Ë«‚¡ß À√◊Õ°√≥’∑’ËμâÕß¡’°“√√—°…“

欓∫“≈„πÀâÕߺŸâªÉ«¬Àπ—° (intensive care unit; ICU)

®à“¬μ“¡®√‘ß·μà‰¡à‡°‘π√“¬≈– 14,000 ∫“∑ 4) ‡¡◊ËÕºŸâ¡’ ‘∑∏‘

ª√– ß§å®–¢Õ¬â“¬‰ª¬—ßÀπ૬∫√‘°“√ª√–®”À≈—ßæâπ¿“«–«‘°ƒμ

·μàÀπ૬∫√‘°“√‰¡à “¡“√∂®—¥À“‡μ’¬ß√Õß√—∫‰¥â §à“√—°…“

欓∫“≈∑’ˇ°‘¥¢÷ÈπÀ≈—ß·®âß 24 ™—Ë«‚¡ß®π∂÷߇«≈“®”Àπà“¬

Àπ૬∫√‘°“√ª√–®”μâÕß√—∫º‘¥™Õ∫§à“„™â®à“¬μ“¡®√‘ß(40)

°“√„™â∫√‘°“√¿“¬„π‡¢μ  ª ™. ‰¥â°”Àπ¥Õ—μ√“®à“¬μàÕ

1 adjRW ‚¥¬§”π«≥Õ—μ√“®à“¬¿“¬„μâß∫ª√–¡“≥¬Õ¥√«¡

(global budget) ¢Õß·μà≈–√“¬ “¢“‡¢μ  ª ™. μàÕº≈√«¡

adjRW ¿“¬„π√“¬ “¢“‡¢μ ‚¥¬«ß‡ß‘πß∫ª√–¡“≥¬Õ¥√«¡

¢Õß·μà≈–√“¬ “¢“‡¢μ®–μâÕßÀ—°§à“ fixed rate ÕÕ°‰ª°àÕπ

fixed rate π’Ȫ√–°Õ∫¥â«¬ °“√ àßμàբⓡ‡¢μμ“¡°“√„™â

∫√‘°“√°√≥’¡“μ√“ 7 ·≈–°“√„™â∫√‘°“√ ”√Õß‡μ’¬ß Õ¬à“߉√°Á

μ“¡Õ—μ√“®à“¬∑’Ë·μà≈–‡¢μ°”Àπ¥μàÕ 1 adjRW μâÕ߉¡à‡°‘π

9,600 ∫“∑ μàÕ 1 adjRW ´÷ËßμâÕߺà“𧫓¡‡ÀÁπ™Õ∫¢Õß

Õπÿ°√√¡°“√À≈—°ª√–°—π ÿ¢¿“懢μ (Õª ¢.) πÕ°®“°°“√

®à“¬μ“¡ DRG  ª ™. ¬—ß°”Àπ¥°“√®à“¬‡ß‘π°Õß∑ÿπ°≈“ß

°√≥’∫√‘°“√∑’Ë¡’§à“„™â®à“¬ Ÿß·≈–°“√∫√‘À“√®—¥°“√‡©æ“– (§à“

„™â®à“¬ Ÿß/Õÿ∫—쑇Àμÿ ‡®Á∫ªÉ«¬©ÿ°‡©‘π/∫√‘°“√‚√§‡©æ“–) „π√Ÿª

·∫∫Õ◊ËπÊ ¥â«¬ ‡æ◊ËÕ √â“ß·√ß®Ÿß∑“ß°“√‡ß‘π∑’ˇÀ¡“– ¡·°à

Àπ૬∫√‘°“√„π°“√„™â∑√—欓°√Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ ¡’§ÿ≥¿“æ

·≈–∑”„Àâª√–™“™π‡¢â“∂÷ß∫√‘°“√ ÿ¢¿“æ∑’Ë¡’§à“„™â®à“¬ ŸßÕ¬à“ß

‡∑à“‡∑’¬¡ ‚¥¬°”Àπ¥√–∫∫°“√®à“¬™¥‡™¬·°àÀπ૬∫√‘°“√

¥â«¬√–∫∫ Point System with Ceiling with Global bud-

get ´÷Ë߇ªìπ°“√®à“¬‡æ‘Ë¡‡μ‘¡®“°°“√®à“¬ª°μ‘μ“¡ DRG(39)

3.2.2 °“√𔉪„™â„π√–∫∫ª√–°—π —ߧ¡

°“√®à“¬™¥‡™¬¿“¬„μâ√–∫∫ DRG ¢Õß√–∫∫

ª√–°—π —ߧ¡ „πªï æ.». 2544 ·μà‡¥‘¡„™â‡ªìππÈ”Àπ—°„π°“√

®—¥ √√ß∫¿“√–‡ ’ˬ߇æ‘Ë¡‡μ‘¡ μàÕ¡“„πªï æ.». 2555 ®÷ßπ”√–∫∫

DRG ¡“„™â„π√–∫∫°“√§≈—ß ÿ¢¿“æ‡æ◊ËÕ®à“¬™¥‡™¬·°à‚√ß

欓∫“≈°√≥’ºŸâªÉ«¬„π ‚¥¬®à“¬¿“¬„μâß∫¬Õ¥√«¡ ”À√—∫

°≈ÿà¡‚√§∑’Ë¡’§à“πÈ”Àπ—° —¡æ—∑∏å¡“°°«à“À√◊Õ‡∑à“°—∫ 2 ´÷Ëß

°”Àπ¥Õ—μ√“∞“π (base rate) ‰¡à‡°‘π 15,000 ∫“∑ μàÕ 1 adjRW

 à«π∑’ËμË”°«à“ 2 „ÀâÕ¬Ÿà„πß∫‡À¡“®à“¬√“¬À—«∑’Ë‚√ß欓∫“≈‰¥â

√—∫(41)

3.2.3 °“√𔉪„™â„π√–∫∫ «— ¥‘°“√√—°…“

欓∫“≈¢â“√“™°“√

°√¡∫—≠™’°≈“߇√‘Ë¡„™â√–∫∫ DRG ®à“¬™¥‡™¬·°à

‚√ß欓∫“≈°√≥’ºŸâªÉ«¬„π ‘∑∏‘ «— ¥‘°“√√—°…“欓∫“≈

¢â“√“™°“√„πªï æ.». 2550 ‚¥¬®à“¬„πÕ—μ√“∞“π∑’˪√—∫μ“¡

√–¥—∫ ∂“π欓∫“≈ ™à«ß·√°‡ªìπÕ—μ√“¢Õß·μà≈–‚√ß欓∫“≈

μàÕ¡“°√¡∫—≠™’°≈“߉¥â®—¥°≈ÿà¡‚√ß欓∫“≈‡æ◊ËÕ≈¥§«“¡·ª√

ª√«π¢ÕßÕ—μ√“®à“¬ ‚¥¬„πªï 2551 ¬ÿ∫‡À≈◊Õ 82 °≈ÿà¡ ·≈–

≈¥‡À≈◊Õ 64, 50 ·≈– 24 °≈ÿà¡ „πªï æ.». 2552, 2553 ·≈–

2554 μ“¡≈”¥—∫ ≈à“ ÿ¥ªï æ.» 2555 ¡’‚√ß欓∫“≈∑—ÈßÀ¡¥ 25

°≈ÿà¡(41) ‚¥¬®—¥°≈ÿà¡‚√ß欓∫“≈μ“¡ —ß°—¥ ‡™àπ ‚√ß欓∫“≈

 —ß°—¥ ”π—°ª≈—¥°√–∑√«ß “∏“√≥ ÿ¢ °√–∑√«ß “∏“√≥ ÿ¢ ‚√ß

欓∫“≈„π —ß°—¥°√ÿ߇∑æ¡À“π§√ ‚√ß欓∫“≈®‘쇫™ —ß°—¥

°√¡ ÿ¢¿“æ®‘μ ·≈–‚√ß欓∫“≈ —ß°—¥°√–∑√«ß»÷°…“∏‘°“√ ́ ÷Ëß

‡ªìπ‚√ß欓∫“≈¡À“«‘∑¬“≈—¬ ·≈–®—¥°≈ÿ࡬àÕ¬μ“¡»—°¬¿“æ

¢Õß‚√ß欓∫“≈¥â«¬(42)

3.3 ªí≠À“∑’Ëæ∫„π√–∫∫°“√‡∫‘°®à“¬¿“¬„μâ√–∫∫

DRG

3.3.1 ªí≠À“¥â“π√–∫∫¢âÕ¡Ÿ≈

°“√μ√«® Õ∫§ÿ≥¿“æ°“√„Àâ√À— ‚√§¢Õß°Õß

∑ÿπÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ ‚¥¬μ√«® Õ∫‡«™√–‡∫’¬π„π

ªïß∫ª√–¡“≥ 2551 ∑—ÈßÀ¡¥ 57,828 ©∫—∫ ®“°Àπ૬∫√‘°“√

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

10

931 Àπ૬ „π 75 ®—ßÀ«—¥ ¬°‡«âπ°√ÿ߇∑æ¡À“π§√ æ∫«à“

¢âÕ¡Ÿ≈°“√«‘π‘®©—¬‚√§√Õß¡’§«“¡º‘¥æ≈“¥∫àÕ¬∑’Ë ÿ¥√âÕ¬≈–

28.40 ·≈–¡’°“√«‘π‘®©—¬‚√§À≈—°‰¡à∂Ÿ°μâÕß√âÕ¬≈– 17.98 ´÷Ëß™’È

„Àâ‡ÀÁπ°“√ √ÿª¢âÕ¡Ÿ≈∑’Ë¡’§«“¡ ”§—≠º‘¥æ≈“¥  ª ™. ®÷ß

¡’·ºπ π—∫ πÿπ°“√«‘®—¬‡æ◊ËÕæ—≤π“√–∫∫°“√„Àâ√À— ∑’Ë¡’

ª√– ‘∑∏‘¿“æ ∑—Èßπ’ȇæ◊ËÕ‡æ‘Ë¡§ÿ≥¿“æ¢Õß√–∫∫¢âÕ¡Ÿ≈(43) ‚¥¬

»÷°…“∂÷ßªí®®—¬∑’Ë àߺ≈μàÕ§ÿ≥¿“æ·≈–§«“¡∂Ÿ°μâÕߢÕß√–∫∫

°“√„Àâ√À—  ªí®®—¬∑’Ë àߺ≈μàÕ√–∫∫°“√„Àâ√À—  §◊Õ ªí®®—¬¿“¬„π

‡™à𠧫“¡™”π“≠°“√ °“√¢—¥·¬âß°—π¢Õß∫ÿ§≈“°√ ªí®®—¬¥â“π

°“√®—¥°“√¢Õß‚√ß欓∫“≈·μà≈–ª√–‡¿∑·≈–¢π“¥ ªí®®—¬

¥â“π°“√‡ß‘π¢Õß‚√ß欓∫“≈ ´÷Ëß°“√‡¢â“∂÷ߢâÕ¡Ÿ≈∑’Ë·∑â®√‘߇™àπ

¢âÕ¡Ÿ≈°“√‡ß‘π „π∫“ß°√≥’∂◊Õ‡ªìπ‡√◊ËÕ߬“° ‚¥¬æ∫«à“¢âÕ¡Ÿ≈

°“√‡ß‘π¢Õß‚√ß欓∫“≈¡’§«“¡·ª√ª√«π Ÿßμ—Èß·μà√âÕ¬≈– 7

∂÷ß√âÕ¬≈– 65(44) °“√„™â√–∫∫ DRG „π°“√‡∫‘°®à“¬„π√–∫∫

°“√§≈—ß “∏“√≥ ÿ¢®÷߬—ߧßμâÕß°“√°“√æ—≤π“ ·≈–ª√—ߪ√ÿß

Õ¬à“ßμàÕ‡π◊ËÕß

3.3.2 ªí≠À“ DRG creep

ªí≠À“§«“¡∫‘¥‡∫’Ȭ«¢ÕߢâÕ¡Ÿ≈®π∑”„À⇰‘¥

ª√“°Ø°“√≥å DRG creep ‡ªìπº≈°√–∑∫‡™‘ß≈∫¥â“π®√‘¬∏√√¡

∑’ˇ°‘¥¢÷Èπ·≈–æ∫‰¥â„π™à«ß∑’˺à“π¡“(45,26)  à«πÀπ÷Ë߇°‘¥®“°

‚ª√·°√¡®—¥°≈ÿà¡¡’®ÿ¥ÕàÕπ‚¥¬‡©æ“–„π™à«ß·√°¢Õß°“√

æ—≤π“√–∫∫ DRG ®ÿ¥ÕàÕπ∑’Ë«à“π’ȧ◊Õ °“√∑’Ë‚ª√·°√¡®—¥°≈ÿà¡

„Àâº≈≈—æ∏凪ìπ°≈ÿà¡‚√§∑’ˉ¡à¡’§«“¡À¡“¬ (DRG Ungroupable)

®”π«π¡“° ‚√ß欓∫“≈®÷ßμâÕß欓¬“¡ª√—∫¢âÕ¡Ÿ≈‡æ◊ËÕ„Àâ

 “¡“√∂®—¥‚√§‡¢â“°≈ÿà¡ DRG ‰¥â  àߺ≈„Àâ¢âÕ¡Ÿ≈‰¡àμ√ߧ«“¡

‡ªìπ®√‘ß ¬‘Ë߉ª°«à“π—Èπ§◊Õ°“√∑’ËÀπ૬∫√‘°“√欓¬“¡„ à√À— ®π

‰¥â DRG ∑’Ë¡’§à“πÈ”Àπ—° —¡æ—∑∏堟߇°‘π°«à“§«“¡‡ªìπ®√‘ß(26) ‚√ß

欓∫“≈∫“ß·Àà߬—߇ªî¥‡º¬«à“ °“√°√–∑”‡™àππ’È∂◊Õ‡ªìπ«‘∏’Àπ÷Ëß

∑’Ë∑”„Àâ‚√ß欓∫“≈¡’√“¬‰¥â‡æ‘Ë¡¢÷Èπ(44)

3.3.3 ªí≠À“¥â“πÕ—μ√“®à“¬™¥‡™¬·≈–°“√‰¥â

‡ª√’¬∫-‡ ’¬‡ª√’¬∫®“°°“√π”√–∫∫ DRG ‰ª„™â

„π°“√æ—≤π“√–∫∫ DRG μ—Èß·μà©∫—∫∑’Ë 1 ∂÷ß©∫—∫∑’Ë

5 «—μ∂ÿª√– ß§åÀ≈—° §◊Õ °“√ª√—∫§à“πÈ”Àπ—° —¡æ—∑∏å„À¡à

(recalibration) „Àâ¡’§«“¡ ¡∫Ÿ√≥å §√Õ∫§≈ÿ¡  Õ¥§≈âÕß°—∫

°“√„™â∑√—欓°√„π°“√√—°…“¬‘Ëߢ÷Èπ(27) ·μà°“√¢“¥§«“¡ ¡∫Ÿ√≥å

¢ÕߢâÕ¡Ÿ≈∑”„Àâ§à“πÈ”Àπ—° —¡æ—∑∏å∑’ˉ¥â‰¡à –∑âÕπμâπ∑ÿπ∑—ÈßÀ¡¥

°àÕ„À⇰‘¥ªí≠À“°“√‰¥â‡ª√’¬∫-‡ ’¬‡ª√’¬∫¢Õß°“√‰¥â√—∫§à“

™¥‡™¬(26) ªí≠À“§«“¡‰¡à ¡∫Ÿ√≥å¢ÕߢâÕ¡Ÿ≈™’È„Àâ‡ÀÁ𧫓¡®”‡ªìπ

¢ÕßÀπ૬∫√‘°“√„π°“√æ—≤π“√–∫∫¢âÕ¡Ÿ≈„Àâ¡’§«“¡∂Ÿ°μâÕß

¬‘Ëߢ÷Èπ ∂â“¢âÕ¡Ÿ≈¡’§«“¡∂Ÿ°μâÕß¡“°¢÷Èπ·≈– “¡“√∂π”¡“

«‘‡§√“–À剥â®√‘߇æ◊ËÕæ—≤π“√–∫∫ DRG ªí≠À“°“√‰¥â‡ª√’¬∫

-‡ ’¬‡ª√’¬∫¢Õß°“√‰¥â√—∫§à“™¥‡™¬∑’ˉ¡à –∑âÕπμâπ∑ÿπ¢Õß

Àπ૬∫√‘°“√°Á®–≈¥≈ß

πÕ°®“°°“√°”Àπ¥§à“πÈ”Àπ—° —¡æ—∑∏å∑’ˉ¡à –∑âÕπ

μâπ∑ÿπ∑’Ë·∑â®√‘ß·≈â« ªí≠À“¥â“πÕ—μ√“°“√®à“¬™¥‡™¬¬—߇°‘¥

®“°°“√‰¥â√—∫‡ß‘𙥇™¬∑’ËμË”‡°‘π‰ª‡π◊ËÕß®“°°“√°”Àπ¥

‡æ¥“πß∫ª√–¡“≥ (global budget) Õ’° “‡ÀμÿÀπ÷Ëߧ◊Õ°“√∑’Ë

¿“§√—∞¡‘‰¥â®à“¬™¥‡™¬μâπ∑ÿπ§à“≈ß∑ÿπ§√ÿ¿—≥±å ´÷Ë߇ªìπß∫

Õÿ¥Àπÿπ®“°¿“§√—∞ ∑”„À⇰‘¥ªí≠À“°“√‰¥â√—∫‡ß‘𙥇™¬„π

Õ—μ√“∑’ËμË”°«à“§«“¡‡ªìπ®√‘ß(45)

4. º≈°√–∑∫®“°°“√„™â√–∫∫ DRG

°≈‰°°“√‡ß‘π∑’Ë„™â„π√–∫∫‡∫‘°®à“¬§à“∫√‘°“√·°à‚√ß

欓∫“≈§«√‡ªìπ°≈‰°∑’ËÀπÿπ‡ √‘¡°√–∫«π°“√∑”ß“π¢Õß

¿“§ à«π “∏“√≥ ÿ¢„À⇪ìπ‰ª¥â«¬¥’ ¡’§«“¡‚ª√àß„  μ√«®

 Õ∫‰¥â Õ¬à“߉√°Á¥’ °“√π”‡Õ“√–∫∫ DRG ¡“„™â„π√–∫∫°“√

‡ß‘π°“√§≈—ß “∏“√≥ ÿ¢°Á¡‘Õ“®À≈’°‡≈’ˬߺ≈°√–∑∫μàÕ√–∫∫

 “∏“√≥ ÿ¢‰¥â

„π¬ÿ‚√ª¡’°“√√«¡μ—«¢Õß°≈ÿࡺŸâ‡™’ˬ«™“≠®“°ª√–‡∑»

 ¡“™‘°‡ªìπ°≈ÿà¡Õߧå°√™◊ËÕ HOPE ´÷Ë߇ªìπÕߧå°√∑’ˉ¡à· «ßÀ“

°”‰√ HOPE ‰¥â√«¡√«∫Õߧ姫“¡√Ÿâ‡°’ˬ«°—∫√–∫∫ DRG „π

ª√–‡∑» ¡“™‘°‰«â Àπ÷Ëß„πª√–‡¥Áπ∑’Ëπà“ π„®∑’Ë¡’°“√»÷°…“§◊Õ

燪ѓÀ¡“¬¢Õߪ√–‡∑»μà“ßÊ ∑’Ëπ” DRG ‰ª„™â„π√–∫∫°“√‡ß‘π

°“√§≈—ß “∏“√≥ ÿ¢é Õ“∑‘ ª√–‡∑»ÕÕ ‡μ√‡≈’¬¡’‡ªÑ“À¡“¬‡æ◊ËÕ

‡æ‘Ë¡§«“¡‚ª√àß„ „π√–∫∫ “∏“√≥ ÿ¢ ‡æ‘Ë¡ª√– ‘∑∏‘¿“æ·≈–

ª√– ‘∑∏‘º≈¢Õß°“√„Àâ∫√‘°“√ ·≈–≈¥Õ—μ√“§à“„™â®à“¬∑’ˇæ‘Ë¡ Ÿß¢÷Èπ

ª√–‡∑»Õ—ß°ƒ…¡’‡ªÑ“À¡“¬‡æ◊ËÕ„Àâßà“¬μàÕ°“√®—¥ √√ß∫ª√–¡“≥

‡ªìπ°“√®à“¬‡ß‘πμ“¡ºŸâªÉ«¬ ºŸâªÉ«¬‡¢â“√—∫°“√√—°…“∑’Ë„¥°Á‰¥â„π

ª√–‡∑»¿“¬„μâ§à“√—°…“‡¥’¬«°—π ·≈–≈¥‡«≈“°“√√Õ§Õ¬‡æ◊ËÕ

Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

11

√—∫°“√√—°…“ ª√–‡∑»‡π‡∏Õ√å·≈π¥å¡’‡ªÑ“À¡“¬‡æ◊ËÕ‡æ‘Ë¡

º≈≈—æ∏å·≈–ª√– ‘∑∏‘¿“æ„π°“√¥”‡π‘πß“π ·≈–‡æ‘Ë¡§«“¡

‚ª√àß„ „π√–∫∫¢Õß‚√ß欓∫“≈ ´÷Ëß “¡“√∂𔉪„™â‡ªìπμ—«™’È

«—¥‡ª√’¬∫‡∑’¬∫ ¡√√∂π–¢Õß√–∫∫°“√„Àâ∫√‘°“√ “∏“√≥ ÿ¢

䴉(46)

°“√»÷°…“º≈°√–∑∫¢Õß°“√π”√–∫∫ DRG ‰ª„™â„π

√–∫∫°“√§≈—ß ÿ¢¿“æ¡’‡ªìπ®”π«π¡“° μ—Èß·μà‡√‘Ë¡¡’°“√·π–π”

√–∫∫ DRG ®π∂÷ßªí®®ÿ∫—π ‚¥¬„™â‡ªìπÀ≈—°∞“π‡™‘ßª√–®—°…å

 π—∫ πÿπ«à“√–∫∫ DRG  àߺ≈¥’À√◊Õº≈‡ ’¬μàÕ√–∫∫

 “∏“√≥ ÿ¢À√◊Õ‰¡àÕ¬à“߉√ ‡™àπ „πª√–‡∑»Õ—ß°ƒ…¡’°“√

ª√–‡¡‘π√–∫∫°“√®à“¬™¥‡™¬·∫∫ Payment by Results (PbR)

√–¥—∫™“μ‘„πªï §.». 2007 Õ¬à“ß√Õ∫¥â“π ´÷Ëß„™â√–∫∫ HRGs

„π°“√®—¥°≈ÿࡺŸâªÉ«¬ æ∫«à“ PbR ∑”„Àâμâπ∑ÿπμàÕÀπ૬ (unit

cost) ≈¥≈ßÕ¬à“ß√«¥‡√Á« ´÷ËßÕ“®‡ªìπº≈®“°°“√∑’˪√–‡∑»

Õ—ß°ƒ…°”Àπ¥Õ—μ√“®à“¬‚¥¬„™â§à“°≈“ß∑’ˉ¥â®“°§à“‡©≈’ˬ (mean)

μâπ∑ÿπ‚√ß欓∫“≈ ∑”„Àâ‚√ß欓∫“≈®”π«πª√–¡“≥§√÷ËßÀπ÷Ëß

¡’μâπ∑ÿπμË”°«à“§à“‡©≈’ˬ ‚√ß欓∫“≈∑’Ë¡’μâπ∑ÿπμË”°«à“§à“‡©≈’ˬ

®÷߇°‘¥·√ß®Ÿß„®∑’Ë®–√—°…“√–¥—∫μâπ∑ÿπ„ÀâμË”°«à“§à“‡©≈’ˬμâπ∑ÿπ

À√◊Õ欓¬“¡ª√—∫≈¥μâπ∑ÿπ„ÀâπâÕ¬≈ß°«à“‡¥‘¡ ®÷ßÕ“®‡ªìπ

ªí®®—¬Àπ÷Ëß∑’Ë∑”„Àâ°“√ª√–‡¡‘π§√—Èßπ’ȉ¡àæ∫§«“¡ —¡æ—π∏å

√–À«à“ß°“√‡æ‘Ë¡¢÷Èπ¢Õߧÿ≥¿“æ∫√‘°“√‡¡◊ËÕ¡’°“√„™â√–∫∫°“√

®à“¬™¥‡™¬·∫∫ PbR ́ ÷Ëßμ—«™’È«—¥∑’Ë„™â§◊Õ Õ—μ√“°“√쓬 ·≈–Õ—μ√“

emergency readmission ¿“¬„π 30 «—𠇪√’¬∫‡∑’¬∫

√–À«à“ß‚√ß欓∫“≈∑’ˇªìπ Foundation Trust ·≈– non-Foun-

dation Trust °√≥’ºŸâªÉ«¬°√–¥Ÿ° –‚æ°À—°(47)

„πª√–‡∑»‡¬Õ√¡π’ æ∫§«“¡º‘¥æ≈“¥∑’ˇ°‘¥®“°°“√„Àâ

√À—  ICD-10 ´÷Ë߇ªìπªí≠À“∑’Ëæ∫‰¥â‚¥¬∑—Ë«‰ªÀ“°¡‘‰¥â¡’

¡“μ√°“√°“√®—¥°“√·≈–μ√«® Õ∫√–∫∫¢âÕ¡Ÿ≈∑’Ë¥’ „π∫“ߧ√—Èß

æ∫«à“√–∫∫ DRG  √â“ß·√ß®Ÿß„®·°àºŸâ„Àâ∫√‘°“√„π°“√„Àâ

¢âÕ¡Ÿ≈∑’Ë∫‘¥‡∫’Ȭ«À√◊Õ∑’ˇ√’¬°«à“ çDRG creepé ‚¥¬®ß„®„ à

√À— ∑’Ë Ÿß¢÷Èπ (up-coding) À√◊Õ„ à√À— º‘¥ (wrong-coding)

‡æ◊ËÕ„À≥â§à“ DRG ∑’Ë Ÿß¢÷Èπ √“¬‰¥â¢Õß‚√ß欓∫“≈®–‰¥â‡æ‘Ë¡

¡“°¢÷Èπ πÕ°®“°π’Ȭ—ß¡’§«“¡°—ß«≈‡°’ˬ«°—∫°“√®”Àπà“¬ºŸâªÉ«¬

°àÕπ‡«≈“Õ—π§«√ ´÷Ëß®”‡ªìπμâÕß¡’¡“μ√°“√∫“ßÕ¬à“ß„π°“√

®—¥°“√ ª√–‡∑»‡¬Õ√¡π’¡’¡“μ√°“√μ√«® Õ∫¢âÕ¡Ÿ≈‚√ß欓∫“≈

‚¥¬ ÿà¡μ√«® ‡æ◊ËÕªÑÕß°—πªí≠À“¢âÕ¡Ÿ≈∫‘¥‡∫’Ȭ« ·≈–®—¥°“√

§«“¡°—ß«≈‡°’ˬ«°—∫°“√®”Àπà“¬ºŸâªÉ«¬°àÕπ‡«≈“Õ—π§«√ ‚¥¬„™â

2 ¡“μ√°“√À≈—° ¡“μ√°“√∑’ËÀπ÷Ëß §◊Õ °“√§”π«≥Õ—μ√“®à“¬

(case fee catalogue), °“√§”π«≥§à“πÈ”Àπ—°μâπ∑ÿπ, ·≈–

°“√§”π«≥®ÿ¥μ—¥ (trim-point) „À¡à∑ÿ°ªï ‡æ◊ËÕ°”Àπ¥Õ—μ√“

®à“¬™¥‡™¬∑’ˇÀ¡“– ¡ ”À√—∫∫√‘°“√∑’Ë¡’√“§“·æß ¢≥–

‡¥’¬«°—π°Áª√—∫≈¥Õ—μ√“®à“¬™¥‡™¬°√≥’ºŸâªÉ«¬μ°‡°≥±å‡æ√“–

«—ππÕπ —Èπ°«à“‡°≥±å ‡æ◊ËÕ≈¥·√ß®Ÿß„®„π°“√®”Àπà“¬ºŸâªÉ«¬

°àÕπ‡«≈“Õ—π§«√ ¡“μ√°“√∑’Ë Õß „™â°√≥’ºŸâªÉ«¬∑’Ë¡’ readmis-

sion  ”À√—∫‚√§‡¥’¬«°—π¿“¬„π 30 «—π À≈—ß®”Àπà“¬ ‚¥¬‚√ß

欓∫“≈®–‰¥â√—∫Õ—μ√“®à“¬™¥‡™¬¿“¬„μâ‡ß◊ËÕπ‰¢‡¥‘¡μ“¡ DRG

·≈–‰¡à‰¥â√—∫Õ—μ√“®à“¬™¥‡™¬‡æ‘Ë¡(20)

«‘®“√≥å

√–∫∫ DRG ‡ªìπ√–∫∫∑’Ë¡’°“√»÷°…“‡ªìπ√–¬–‡«≈“π“π ®π

 “¡“√∂π”¡“„™â„π√–∫∫‡∫‘°®à“¬§à“√—°…“欓∫“≈·°à‚√ß

欓∫“≈ °“√π”√–∫∫ DRG ‰ª„™â„π√–∫∫°“√§≈—ß

 “∏“√≥ ÿ¢®”‡ªìπμâÕß∑”°“√»÷°…“§«“¡‡ªìπ¡“·≈–·π«§‘¥

‡æ◊ËÕ„À⇰‘¥§«“¡‡¢â“„®„π·μà≈–∫√‘∫∑ ‡π◊ËÕß®“°∫√‘∫∑¢Õß

·μà≈–ª√–‡∑»¡’§«“¡·μ°μà“ß ·π«§‘¥∫“ߪ√–°“√®÷ß·μ°μà“ß

°—π ®÷߇ªìπ‡Àμÿº≈∑’Ë∫“ߪ√–‡∑» ‡™àπ ‡π‡∏Õ√å·≈π¥å Õ—ß°ƒ…

·≈–ÕÕ ‡μ√’¬ ‡ªìπμâπ ‡≈◊Õ°∑’Ë®–æ—≤π“√–∫∫ DRG „π·∫∫

©∫—∫∑’ˇÀ¡“– ¡ ”À√—∫ª√–‡∑»¢Õßμπ

°“√æ—≤π“√–∫∫ DRG §«√‡√‘Ë¡®“°°“√æ—≤π“∞“π¢âÕ¡Ÿ≈

‡π◊ËÕß®“°°“√®—¥°≈ÿࡺŸâªÉ«¬μâÕß„™â¢âÕ¡Ÿ≈„π°“√«‘‡§√“–Àå·≈–

 —߇§√“–Àå ∑—ÈߢâÕ¡Ÿ≈ºŸâªÉ«¬·≈–¢âÕ¡Ÿ≈°“√„™â∑√—欓°√„π°“√

√—°…“ °“√®—¥‡°Á∫¢âÕ¡Ÿ≈¥—ß°≈à“«®”‡ªìπμâÕß·ª≈ß„À⇪ìπß“π

ª√–®”(9) ¢âÕ¡Ÿ≈®”‡ªìπ ‰¥â·°à ‡æ» Õ“¬ÿ °“√«‘π‘®©—¬‚√§À≈—°

°“√«‘π‘®©—¬‚√§√Õß À—μ∂°“√ √–¬–‡«≈“‡¢â“√—∫°“√√—°…“

 ¿“æ°“√®”Àπà“¬ μ≈Õ¥®πμâπ∑ÿπ¢Õß°“√√—°…“·μà≈–§√—Èß(10)

À“°¡’¢âÕ¡Ÿ≈‡À≈à“π’ȧ√∫∂â«π·≈–¡’√–∫∫°“√®—¥‡°Á∫¢âÕ¡Ÿ≈∑’ˉ¥â

¡“μ√∞“π °“√®—¥°≈ÿࡺŸâªÉ«¬·∫∫ DRG °Á®–¡’§«“¡πà“‡™◊ËÕ∂◊Õ

¬‘Ëߢ÷Èπ

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

12

·¡â√–∫∫ DRG ®–®—¥°≈ÿà¡‚√§®”π«π¡“°∑’Ë¡’„π√–∫∫

¢âÕ¡Ÿ≈¢Õß‚√ß欓∫“≈‰¥â‡ªìπÕ¬à“ߥ’ °√–π—Èπ°Á¬—ß¡’¢âÕ§«√

§”π÷ß∂÷ßÕ¬à“ß¡“°§◊Õ¢âÕ¡Ÿ≈μâπ∑ÿπ‚√ß欓∫“≈ ‡π◊ËÕß®“°ºŸâ„Àâ

∫√‘°“√μâÕß°“√‰¥â√—∫§«“¡‡ªìπ∏√√¡„π‡√◊ËÕߢÕß§à“„™â®à“¬∑’Ë®–

μâÕß·∫°√—∫ ºŸâæ—≤π“®÷ßμâÕß¡’§«“¡‡¢â“„®‚§√ß √â“ßμâπ∑ÿπ¢Õß

‚√ß欓∫“≈«à“ª√–°Õ∫¥â«¬Õ–‰√∫â“ß πÕ°®“°π’Ȭ—ß¡’ªí®®—¬

ª√–°Õ∫°“√ª√—∫§à“Õ◊ËπÊ ∑’Ë àߺ≈μàÕ°“√§”π«≥Õ—μ√“®à“¬∑’Ë

‡À¡“– ¡·°à‚√ß欓∫“≈¥â«¬ ®÷ßÕ“®μâÕß¡’°“√«‘‡§√“–À姫“¡

 ”§—≠¢Õßªí®®—¬μà“ßÊ ‡À≈à“π’ȇæ‘Ë¡‡¢â“‰ª„π°“√§”π«≥Õ—μ√“

®à“¬™¥‡™¬∑’Ë ‡À¡“– ¡‡æ◊ËÕ √â“ß·√ß®Ÿß„®·°àºŸâ„Àâ∫√‘°“√

 ”À√—∫°≈ÿࡺŸâªÉ«¬μ°‡°≥±å °≈ÿà¡∫√‘°“√∑’Ë¡’§à“„™â®à“¬ Ÿß ·≈–

°≈ÿà¡∑’Ë„™â‡∑§‚π‚≈¬’„À¡àÀ√◊Õ°“√√—°…“∑’ËμâÕß„™â‡∑§‚π‚≈¬’‡©æ“–

Õ“®μâÕß„™â«‘∏’°“√®à“¬∑’Ë·μ°μà“ßÕÕ°‰ª ‡™àπ ®à“¬μ“¡§à“„™â

®à“¬∑’ˇ°‘¥¢÷Èπ®√‘ß ®à“¬‡æ‘Ë¡‡μ‘¡ À√◊ÕÀ—°≈¥Õ—μ√“®à“¬ ‡ªìπμâπ(22)

«≈’ ç‡À√’¬≠¡’ Õߥâ“πé À√◊Õ„π¿“…“Õ—ß°ƒ…∑’Ë«à“ çevery

coin has two sidesé πà“®– –∑âÕπ∂÷ߧ«“¡‡ªìπ®√‘ߢÕß°“√

„™â√–∫∫ DRG „π√–∫∫°“√§≈—ß “∏“√≥ ÿ¢ ‡æ√“–√–∫∫ DRG

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Journal of Health Systems Research Vol. 8 No. 1 January-March 2014

13

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§”·π–π”„π°“√‡¢’¬π∫∑∫√√≥π‘∑—»πåπ’È

‡Õ° “√Õâ“ßÕ‘ß

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2555 ‡√◊ËÕß ¡“μ√°“√‡°’ˬ«°—∫√–∫∫∫√‘À“√¬“ ‡«™¿—≥±å °“√‡∫‘°®à“¬

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¡‘∂ÿπ“¬π 2555 ‡√◊ËÕß ¡“μ√°“√‡°’ˬ«°—∫√–∫∫∫√‘À“√¬“ ‡«™¿—≥±å

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‡§√◊ËÕß¡◊Õ„π°“√°”Àπ¥√“§“·≈–æ—≤π“§ÿ≥¿“. ·æ∑¬ ¿“ “√ 2540;

«“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557

14

26:134-42.

24. »ÿ¿™—¬ §ÿ≥“√—μπ惰…å·≈–»ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬. °“√æ—≤π“

°≈‰°°“√®à“¬‡ß‘π∑’Ë¡’ª√– ‘∑∏‘¿“æ„π√–∫∫ “∏“√≥ ÿ¢¥â«¬°≈ÿà¡

«‘π‘®©—¬‚√§√à«¡ √“¬ß“π«‘®—¬  ∂“∫—π«‘®—¬ “∏“√≥ ÿ¢‰∑¬ ·≈–

Õߧ尓√Õπ“¡—¬‚≈°; 2540.

25. »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬. °≈ÿà¡«‘π‘®©—¬‚√§√à«¡: À≈—°°“√·≈–°“√„™â

ª√–‚¬™πå. æ‘…≥ÿ‚≈°: »Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ

ππ∑∫ÿ√’:  ”π—°ß“πª√–°—π ÿ¢¿“æ °√–∑√«ß “∏“√≥ ÿ¢; 2543.

26. »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚√∑—¬. °≈ÿà¡«‘π‘®©—¬‚√§√à«¡: °“√æ—≤π“·≈–°“√„™â

ª√–‚¬™πå„πª√–‡∑»‰∑¬ (Diagnosis related group: Developments

and Uses in Thailand. ππ∑∫ÿ√’:  ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢·≈–

 ”π—°ß“πª√–°—π ÿ¢¿“æ °√–∑√«ß “∏“√≥ ÿ¢; 2544.

27. ‰™¬¬» ª√– “π«ß»å. Thai DRG version 5. ‰ø≈å𔇠πÕ„π°“√

ª√–™ÿ¡™’È·®ßºŸâ∫√‘À“√„π‚√ß欓∫“≈„πÀ—«¢âÕ ç°“√®—¥°≈ÿà¡«‘π‘®©—¬

‚√§√à«¡ ©∫—∫∑’Ë 5é ‡¡◊ËÕ«—π∑’Ë 26 ¡’π“§¡ 2555 ≥ ‚√ß·√¡√“¡“

°“√凥π å °√ÿ߇∑æœ ®—¥‚¥¬  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘;

2555.

28. »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚√∑—¬. DRG °≈ÿà¡«‘π‘®©—¬‚√§√à«¡‰∑¬„π À— 

«√√…Àπâ“: ∫∑§«“¡ª√–°Õ∫°“√∫√√¬“¬ „π°“√ª√–™ÿ¡«‘™“°“√

ª√–®”ªï ‚√ß欓∫“≈æÿ∑∏™‘π√“™ 19 惻®‘°“¬π 2542.

29.  ”π—°ß“πª≈—¥°√–∑√«ß “∏“√≥ ÿ¢ °√–∑√«ß “∏“√≥ ÿ¢. §Ÿà¡◊Õ

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‡≈à¡ 1. Õߧ尓√Õπ“¡—¬‚≈°; 2545.

30. »Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ §≥–·æ∑¬»“ μ√å

¡À“«‘∑¬“≈—¬π‡√»«√ ·≈– ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ.

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¢ÕߺŸâ„Àâ∫√‘°“√ μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡©∫—∫∑’Ë 4; 2550.

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¡À“«‘∑¬“≈—¬π‡√»«√ ·≈– ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ.

¢âÕ‡ πÕ·π–°“√®à“¬‡ß‘πμ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ ”À√—∫ºŸâªÉ«¬„π

√–¬–‡©’¬∫æ≈—π; 2550.

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35. °√–∑√«ß°“√§≈—ß. ª√–°“»°√–∑√«ß°“√§≈—ß ‡√◊ËÕß À≈—°‡°≥±å·≈–

Õ—μ√“§à“√—°…“欓∫“≈ª√–‡¿∑ºŸâªÉ«¬„π  ∂“π欓∫“≈∑“ß√“™°“√

μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (DRGs) (©∫—∫∑’Ë 2) ª√–°“» ≥ «—π∑’Ë 28

¡’π“§¡ æ.». 2555

36.  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. §Ÿà¡◊ÕÀ≈—°ª√–°—π ÿ¢¿“æ

·Ààß™“μ‘ ªïß∫ª√–¡“≥ 2547; 2547

37.  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. §Ÿà¡◊ÕÀ≈—°ª√–°—π ÿ¢¿“æ

·Ààß™“μ‘ ªïß∫ª√–¡“≥ 2548; 2548

38.  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. §Ÿà¡◊ÕÀ≈—°ª√–°—π ÿ¢¿“æ

·Ààß™“μ‘ ªïß∫ª√–¡“≥ 2551; 2551

39.  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. §Ÿà¡◊Õ∫√‘À“√°Õß∑ÿπÀ≈—°

ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ ªïß∫ª√–¡“≥ 2556 ‡≈à¡ 1: °“√∫√‘À“√ß∫

∫√‘°“√∑“ß°“√·æ∑¬å‡À¡“®à“¬√“¬À—«; 2555.

40.  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. §Ÿà¡◊Õ·π«∑“ߪؑ∫—μ‘„π°“√

¢Õ∫√—∫§à“„™â®à“¬‡æ◊ËÕ°“√ “∏“√≥ ÿ¢ ªïß∫ª√–¡“≥ 2555.  ”π—°

∫√‘À“√°“√®à“¬™¥‡™¬§à“∫√‘°“√,  ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘;

2555.

41.  —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï. ·ºπ°“√¥”‡π‘πß“π°“√ª√—∫ª√ÿß°≈‰°°“√

®à“¬μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ ‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡§≥–

Õπÿ°√√¡°“√ª√—∫ª√ÿß°≈‰°°“√®à“¬μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ §√—Èß∑’Ë 1/

2555 «—π∑’Ë 28 ¡‘∂ÿπ“¬π æ.». 2555

42. ‰™¬¬» ª√– “π«ß»å. Õ—μ√“∞“π·≈–°“√®—¥°≈ÿà¡‚√ß欓∫“≈„π°“√

‡∫‘°®à“¬§à“√—°…“欓∫“≈μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡√–∫∫ «— ¥‘°“√

√—°…“欓∫“≈¢â“√“™°“√ ‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡ DRG ºŸâ

∫√‘À“√ ∂“π欓∫“≈¢Õß∑“ß√“™°“√ «—π∑’Ë 24-25 ¡°√“§¡ 2554

 ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ  ∂“∫—π«‘®—¬√–∫∫

 “∏“√≥ ÿ¢; 2554.

43. °ƒ…≥å æß»åæ‘√ÿÃÀå, ª√–¥‘…∞å «ß…å§≥“√—μπ°Ÿ≈. °“√μ√«® Õ∫

§ÿ≥¿“æ°“√„Àâ√À— ‚√§ ”À√—∫°“√®à“¬™¥‡™¬§à“∫√‘°“√ºŸâªÉ«¬„π¢Õß

 ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. «“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢

2551;2:535-545.

44. Pongpirul, K. Hospital coding practice, data quality, and DRG-

based reimbursement under the Thai universal coverage scheme. A

dissertation submitted to Johns Hopkins University in conformity

with the requirements for the degree of Doctor of Philosophy.

Johns Hopkins University; 2011.

45. »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬, ™—¬‚√®πå ´÷ß π∏‘æ√, Õ√∑—¬ ‡¢’¬«‡®√‘≠,

∫ÿªº«√√≥ æ—«æπ∏åª√–‡ √‘∞, π‘≈«√√≥ Õ¬Ÿà¿—°¥’, ‰™¬¬» ª√– “π

«ß»å·≈–§≥–. °“√æ—≤𓇧√◊ËÕß¡◊Õ°“√®à“¬‡ß‘π∫√‘°“√ºŸâªÉ«¬„π¥â«¬

°≈ÿà¡‚√§√à«¡‰∑¬·≈–πÈ”Àπ—° —¡æ—∑∏å©∫—∫∑’Ë 5 (Development of Thai

Casemix version 5 As a Payment Tool for Inpatient Services).

»Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ ¡À“«‘∑¬“≈—¬π‡√»«√

·≈– ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ. °√ÿ߇∑æ¡À“π§√:

 ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘; 2554.

46. HOPE. HOPE report on DRGs as a financing tool. European

Hospital and Healthcare Federation; 2006.

47. Farrar S, Sussex J, Yi D, Sutton, M, Chalkley M, Scott T et al.

Report to the Department of Health. National Evaluation of Pay-

ment by Results. Health Economics Research Unit; 2007.