Review DRG

1. ∫∑∫√√≥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√– ߧå‡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√– ߧåÀ≈—°‡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 contexts
Arnat 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 an
acute-inpatient classification system. Developed by Robert Fetter and his colleagues at Yale University, it
was initially called Yale DRG. The system has been used for over four decades. Patients in the same DRG
group are provided similar services and the hospital’s resources. The DRG-base rate multiplied by the
relative weight and country-specific adjustment factors determines the reimbursement amount. The main
purpose of utilizing the DRG system in health financing is to increase the transparency and efficiency of
hospital services. The advantages and disadvantages of the payment method should be explored so as to
improve 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“√—°…“

2. «“√ “√«‘®—¬√–∫∫ “∏“√≥ 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◊ÕÀπ÷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¥’¬«°—π§«√„™â∫√‘°“√μà“ßÊ
¢Õß‚√ß欓∫“≈∑’˧≈⓬§≈÷ß°—π

3. 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“(adjustmentfactors)°“√§”π«≥§à“πÈ”Àπ—°¢ÕßDRG
¡’ 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√– ߧå‡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°“√

4. «“√ “√«‘®—¬√–∫∫ “∏“√≥ 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“¬∑’Ë30¬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‘®“√≥“

5. 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
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∑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
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·μ°μà“ߢÕßÕ—μ√“§à“®â“ߢÕß∫ÿ§≈“°√μ“¡æ◊Èπ∑’Ë ‚¥¬°”Àπ¥
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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(CostOut-
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)

6. «“√ “√«‘®—¬√–∫∫ “∏“√≥ 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)

7. 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—∑∏å‰¡à –∑âÕπ°“√
„™â∑√—欓°√„π°“√√—°…“ºŸâªÉ«¬√–¥—∫μà“ßÊ(28)
‡¡◊ËÕ§ÿ≥¿“æ¢ÕߢâÕ¡Ÿ≈¥’¢÷Èπ‡ªìπ≈”¥—∫®÷ßæ—≤𓂪√·°√¡
DRG grouper version II ´÷Ëß¡’«—μ∂ÿª√– ߧå‡æ◊ËÕ≈¥º≈≈—æ∏å
¢Õß°“√‰¥â°≈ÿà¡ungroupableDRG‚¥¬¬—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√– ߧåÀ≈—° §◊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—∫

8. «“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557
8
„™â°—∫ºŸâªÉ«¬„π∑’ˉ¥â®”Àπà“¬ÕÕ°®“° ∂“π欓∫“≈μ—Èß·μà«—π∑’Ë1
‡¡…“¬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¡‡ªìπ1.32
‡∑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)

9. 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√– ߧ宖¢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∫√‘°“√

10. «“√ “√«‘®—¬√–∫∫ “∏“√≥ 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¡“¬(DRGUngroupable)
®”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—∑∏å Ÿß‡°‘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“√–∫∫DRGμ—Èß·μà©∫—∫∑’Ë1∂÷ß©∫—∫∑’Ë
5 «—μ∂ÿª√– ߧåÀ≈—° §◊Õ °“√ª√—∫§à“πÈ”Àπ—° —¡æ—∑∏å„À¡à
(recalibration) „Àâ¡’§«“¡ ¡∫Ÿ√≥å §√Õ∫§≈ÿ¡ Õ¥§≈âÕß°—∫
°“√„™â∑√—欓°√„π°“√√—°…“¬‘Ëߢ÷Èπ(27)
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μâπ∑ÿπ∑’Ë·∑â®√‘ß·≈â« ªí≠À“¥â“πÕ—μ√“°“√®à“¬™¥‡™¬¬—߇°‘¥
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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
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‡ß‘π°“√§≈—ß “∏“√≥ ÿ¢°Á¡‘Õ“®À≈’°‡≈’ˬߺ≈°√–∑∫μàÕ√–∫∫
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°”‰√ HOPE ‰¥â√«¡√«∫Õߧ姫“¡√Ÿâ‡°’ˬ«°—∫√–∫∫ DRG „π
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燪ѓÀ¡“¬¢Õߪ√–‡∑»μà“ßÊ ∑’Ëπ” DRG ‰ª„™â„π√–∫∫°“√‡ß‘π
°“√§≈—ß “∏“√≥ ÿ¢é Õ“∑‘ ª√–‡∑»ÕÕ ‡μ√‡≈’¬¡’‡ªÑ“À¡“¬‡æ◊ËÕ
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ª√–‡∑»¿“¬„μâ§à“√—°…“‡¥’¬«°—π ·≈–≈¥‡«≈“°“√√Õ§Õ¬‡æ◊ËÕ

11. 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§◊ÕÕ—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« ·≈–®—¥°“√
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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)
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√–∫∫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·∫∫
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—߇§√“–Àå ∑—ÈߢâÕ¡Ÿ≈ºŸâªÉ«¬·≈–¢âÕ¡Ÿ≈°“√„™â∑√—欓°√„π°“√
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°“√«‘π‘®©—¬‚√§√Õß À—μ∂°“√ √–¬–‡«≈“‡¢â“√—∫°“√√—°…“
¿“æ°“√®”Àπà“¬ μ≈Õ¥®πμâπ∑ÿπ¢Õß°“√√—°…“·μà≈–§√—Èß(10)
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12. «“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ªï∑’Ë 8 ©∫—∫∑’Ë 1 ¡°√“§¡-¡’π“§¡ 2557
12
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¢âÕ¡Ÿ≈¢Õß‚√ß欓∫“≈‰¥â‡ªìπÕ¬à“ߥ’ °√–π—Èπ°Á¬—ß¡’¢âÕ§«√
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∫√‘°“√μâÕß°“√‰¥â√—∫§«“¡‡ªìπ∏√√¡„π‡√◊ËÕߢÕß§à“„™â®à“¬∑’Ë®–
μâÕß·∫°√—∫ ºŸâæ—≤π“®÷ßμâÕß¡’§«“¡‡¢â“„®‚§√ß √â“ßμâπ∑ÿπ¢Õß
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«≈’ 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
¡’∑—Èߥâ“π¥’∑’˙૬„π°“√ à߇ √‘¡√–∫∫ “∏“√≥ ÿ¢„Àâæ—≤𓉪
„π∑“ß∑’Ë¥’¢÷Èπ ·≈–¥â“π∑’Ëæ÷ß√–«—ß °≈à“«§◊Õ À“°ºŸâ„Àâ∫√‘°“√
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∑’˺ŸâªÉ«¬ ª√– ∫°“√≥å¢Õßμà“ߪ√–‡∑»∑’Ë¡’°“√„™â DRG „π
√–∫∫°“√§≈—ß ÿ¢¿“æÕ“®‡ªìπÀπ÷Ëß„π∑“ßÕÕ°®“°À≈“¬Ê ∑“ß
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pital-specific base rate ¡“‡ªìπ state-wide base rate
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≈¥¢âÕ°—ß«≈«à“Õ—μ√“®à“¬™¥‡™¬®–μË”À√◊Õ Ÿß°«à“μâπ∑ÿπ„π°“√
√—°…“ºŸâªÉ«¬ ·μà°“√ª√—∫Õ—μ√“®à“¬μ“¡ DRG √–À«à“ß 3
°Õß∑ÿπ®–‡ªìπ‡Õ°¿“æ‰¡à‰¥âÀ“°°“√°”Àπ¥√“¬°“√∫√‘°“√/
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ª√–°—π ÿ¢¿“æ‰∑¬ ‡§√◊Õ ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ·≈–

13. Journal of Health Systems Research Vol. 8 No. 1 January-March 2014
13
¢Õ¢Õ∫§ÿ≥ 𓬷æ∑¬å∂“«√ °ÿ≈æ“≥‘™¬å ºŸâÕ”π«¬°“√
”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬ ”À√—∫
§”·π–π”„π°“√‡¢’¬π∫∑∫√√≥π‘∑—»πåπ’È
‡Õ° “√Õâ“ßÕ‘ß
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2555 ‡√◊ËÕß ¡“μ√°“√‡°’ˬ«°—∫√–∫∫∫√‘À“√¬“ ‡«™¿—≥±å °“√‡∫‘°®à“¬
§à“μ√«®«‘π‘®©—¬ ·≈–§à“∫√‘°“√∑“ß°“√·æ∑¬å
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¡‘∂ÿπ“¬π 2555 ‡√◊ËÕß ¡“μ√°“√‡°’ˬ«°—∫√–∫∫∫√‘À“√¬“ ‡«™¿—≥±å
°“√‡∫‘°®à“¬§à“μ√«®«‘π‘®©—¬ ·≈–§à“∫√‘°“√∑“ß°“√·æ∑¬å
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13. »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬. °≈ÿà¡«‘π‘®©—¬‚√§√à«¡∑“ß®—°…ÿ«‘∑¬“: §«“¡
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22. Medicare Payment Advisory Commission. Report to the Congress:
Medicare payment policy. Washington (DC), MedPAC; 2002.
23. »ÿ¿™—¬ §ÿ≥“√—μπ惰…å. °≈ÿà¡«‘π‘®©—¬‚√§√à«¡ ”À√—∫ºŸâªÉ«¬Õÿ∫—쑇Àμÿ:
‡§√◊ËÕß¡◊Õ„π°“√°”Àπ¥√“§“·≈–æ—≤π“§ÿ≥¿“. ·æ∑¬ ¿“ “√ 2540;

14. «“√ “√«‘®—¬√–∫∫ “∏“√≥ 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
°“√®—¥°≈ÿà¡«‘π‘®©—¬‚√§√à«¡·≈–πÈ”Àπ—° —¡æ—∑∏å ©∫—∫∑’Ë 3 æ.». 2545
‡≈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.
À≈—°‡°≥±å°“√®à“¬‡ß‘π·≈–§à“√—°…“μàÕπÈ”Àπ—° —¡æ—∑∏åμ“¡≈—°…≥–
¢ÕߺŸâ„Àâ∫√‘°“√ μ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡©∫—∫∑’Ë 4; 2550.
31. »Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ §≥–·æ∑¬»“ μ√å
¡À“«‘∑¬“≈—¬π‡√»«√ ·≈– ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ.
¢âÕ‡ πÕ·π–°“√®à“¬‡ß‘πμ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ ”À√—∫ºŸâªÉ«¬„π
√–¬–‡©’¬∫æ≈—π; 2550.
32. ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘. °“√®—¥°≈ÿà¡«‘π‘®©—¬‚√§√à«¡
·≈–πÈ”Àπ—° —¡æ—∑∏å ©∫—∫∑’Ë 4.0 æ.». 2550 ‡≈à¡ 1; 2550.
33. —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï, Hughes D, ®‡¥Á® ∏√√¡∏—™Õ“√’, «’√–»—°¥‘Ï
æÿ∑∏“»√’, ·≈– ߧ√“¡™—¬ ≈’∑Õߥ’. °“√ª√–‡¡‘π°“√¥”‡π‘πß“πÀπ÷Ëß
∑»«√√…√–∫∫À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“, ππ∑∫ÿ√’, ”π—°ß“π
«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬; 2555
34. »Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ §≥–·æ∑¬»“ μ√å
¡À“«‘∑¬“≈—¬π‡√»«√ ·≈– ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ
∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢. °“√æ—≤π“°≈ÿà¡‚√§√à«¡©∫—∫∑’Ë 5
‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡ TMI ‚√ß·√¡‡´Áπ∑√“·°√π¥å ‡´Áπ∑√—≈
‡«‘≈¥å °√ÿ߇∑æœ «—π∑’Ë 20 惻®‘°“√¬π 2552
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.
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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«¬
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»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.
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