背景和目的：醫療機構、健保局、病人間有著非常複雜且微妙的給付關係，規劃理想、公平、合理、簡單的給付制度是學術界及醫療界的努力標的。本研究目的嘗試以建立個別醫院診斷組合(DRGs) 之臨床圖譜的給付精神，作為建議健保局與醫療機構雙向溝通、協調機制的依據與手段。方法：以個案醫院本身之尿路結石臨床資料、病人統計、現行及歷史費用分析，經過DRGs 的互補方式，訂出屬於自己個別醫院的平均；以各種疾病之不同臨床狀況案例分配及其住院日、住院費用差異，鋪出個案醫院DRGs (DRG323-324) 的病人臨床圖譜，以做為醫院與健保個別洽定費用時，以此圖譜作為給付依據。結果：個案醫院自2002 年1 月1 日至2005 年10 月31 日止，DRG323的個案共有256 人、其平均住院日為3.2 天、平均住院費用為31,568 元。實施體外震波碎石術的個案共有175 人佔68.4%、其平均住院日為2.7 天、平均住院費用為34,782元，實施內視鏡取石術的病人數共有40 人佔15.6%、其平均住院日為3.2 天、平均住院費用為28,926 元，實施以其他觀察輔助治療的病人共有41 人佔16.0%、其平均住院日為5.3 天、平均住院費用為21,512 元。DRG324 的個案共有215 人、其平均住院日為2.0 天、平均住院費用為17,765 元。實施內視鏡取石術的個案共有134 人佔62.3%、其平均住院日為2.1 天、平均住院費用為21,033 元，實施以其他觀察輔助治療的個案共有81 人佔37.7%、其平均住院日為1.8 天、平均住院費用為7,050 元。結論：以個案醫院尿路結石(DRG323-324) 的病人臨床圖譜分析基礎為例，作為向健保局提出申請給付之依據，相信可防止醫療機構不按醫療保險的政策實施醫療服務，或者醫療保險機構不尊重醫療管理的自身規律干涉醫療服務的弊端，而得到公平而雙方滿意的給付標準。

A fair, reasonable, and simple 'balanced billing' paymentsystem is desired by providers, payers, and patients in the healthcare industry. In this study, wesought to establish the clinical case-mix component for the diagnosis-related groups (DRGs) in anindividual hospital.We analyzed urolithiasis patients' clinical information, and pastand present cost data to establish baseline data for DRG323-324.There were 256patients from January 1, 2002 to December 31, 2005. The average length of stay (LOS) was 3.2 dayswith a mean in-hospital expense of NT$31,568. In total, 175 patients (68.4%) receivedextracorporeal shock wave lithotripsy (ESWL) (with a mean LOS of 2.7 days and expense of NT$34,782); while 40 received endoscopic removal of the urolithiasis (with a mean LOS of 3.2 daysand expense of NT$28,926); the other 41 (16%) were merely observed in the hospital (with a meanLOS of 2.0 days and expense of NT$17,765). For 215 patients who underwent the DRG clinicalpathway, the mean LOS was 2.0 days, and the mean expense was NT$17,765. None of thesepatients received ESWL, while 134 (62.3%) received endoscopic removal (with a mean LOS of 2.1days and expense of NT$21,033), and 81 (37.7%) were medically observed (with a mean LOS of 1.8days and expense of NT$7050).We believe that DRGs can help improve balancedbilling, and we provide evidence for this in this study.