結果發現（一）本研究樣本共被核減125 種藥品，核減點數最高的前三名藥品即佔抽樣處方藥品總核減點數的66.3%。（二）以201 條款：用藥種類與病情不符；202 條款：用藥份量與病情不符；203 條款：用藥種類重複等項目為核減主要原因，此三條款所核減藥品點數更佔藥品總核減點數之78.34%。（三）健保局核減後，醫師申覆獲健保核准補付率為46.5%，但核准補付藥品點數只有24%。（四）本研究核減點數最高的藥品glypressin，依201 條款：用藥種類與病情不符，及202 條款：用藥份量與病情不符而核減，經回推放大後被核減919074 點，即單一藥品核減點數，佔樣本月總核減點數(含非藥品部分)的12.65%。高價藥品的核減原因更值得深入探討。期望本研究發現藥品核減之主要原因，能作為醫院內部管理之參考，由醫師、藥師、相關計價人員相互配合，以最低的營運成本，提供最佳的醫療品質，不僅能保護民眾用藥安全、更可增加醫院的競爭力。
 

Since the implementation of the National  Health  Insurance (NH!) in  1995, the annual growth rate of healthcare expenditure  is  increasing yearly. The sampling audit from NHI becomes  stricter for the limited resources. We conducted  the study to analyze the cause of the disapproved  drug fee claim for the outpatient setting in our hospital  in July 2000. The study shows that there were  I 25 drug items being disapproved.  The top three drugs from the first disapproved claim were responsible for the 66.3% of payments. 78.3% of the regulations for disapproved drugs were code 201  (no indications), code 202 (dosage incompatible) and code 203 (repeat prescriptions).  For reclamation, the approved  reimbursement rate was 46.5% in terms of cases, or 24% in terms of payments. Conclusively,  high cost drugs need more attention  before prescription. To improve the healthcare quality, the regular cause analysis  for disapproved  claim  is suggested.