The aim of this study was to explore the determinants of non-implementation of diagnosis-related groups (DRGs) by hospitals in Colombia. A qualitative case was carried out to analyze the directors' perceptions in six hospitals with and without DRGs in Bogota. The interviews are based on the Innovation Diffusion Theory. The directors had similar perceptions of the determinates. DRGs were seen as positive, but encountered organizational and institutional obstacles. Without a targeted public policy, the likelihood of implementing DRGs in Colombia is slight.