医保支付方式改革是中国医疗卫生体制改革的关键环节，能助力公立医院高质量发展。2020年1月1日，浙江省对全部有住院医疗服务的医院实施DRG点数支付改革。本研究以A院为样本，探究全院层面上DRG支付改革对医疗服务绩效的影响；同时选取内外科具体病种（脑梗死和腹腔镜下胆囊切除术）进行更细致的差异分析，并探究住院天数和住院费用总额的影响因素。 本研究收集A院2019年1月至2021年12月全部住院参保患者的相关信息，以2020年1月1日为干预节点，通过间断时间序列分析法（ITSA）探究DRG支付改革前后全院在医疗服务能力、医疗服务效率、医疗服务质量与医疗服务费用上的变化。针对内外科不同疾病患者，通过倾向得分匹配（PSM）校正基线资料，分别比较患者在DRG支付改革前后各评价指标上的差异，并以广义线性回归模型分析住院天数和住院费用总额的影响因素。 研究发现DRG支付改革后全院CMI值呈下降趋势、总权重有所上升，提示DRG支付可能导致医疗服务能力下降，须开展具体分析并进行针对性管理。DRG支付改革后全院平均住院天数明显缩短，内外科不同疾病患者住院天数显著低于改革前，表明DRG支付可提升医疗服务效率。DRG支付改革后全院出入院诊断一致率改善、死亡率无显著变化；内外科不同疾病患者在诊断是否一致、离院方式和转归情况方面较改革前无明显减退，医疗服务质量整体能得到保障。DRG支付改革后全院次均住院费用总额、次均自负费用与非医疗服务收入占比呈下降趋势，自负费用占比上升，内外科不同疾病患者的总费用显著低于改革前，体现出DRG支付能一定程度控制医疗费用增长，使费用结构趋于合理、患者经济负担减轻。同时内外科不同疾病患者的住院天数与住院费用总额影响因素存在差异，DRG支付改革、年龄与患者来源是共性影响因素；对外科患者来说，临床路径管理是同时影响住院天数与费用总额的关键因素，应受到医院高度关注。 针对上述发现本研究提出DRG支付改革下医院应明确自身定位、提升诊疗能力，避免片面追求平均住院日下降，完善配套政策措施与加强医疗服务精细化管理的建议。

Medical insurance payment reform, as a key part of China’s health care system reform, is capable of supporting high-quality development of public hospitals. On 1st January 2020, DRG point payment reform was implemented for all hospitals with inpatient medical services in Zhejiang Province. In this study, Hospital A was taken as a sample to explore the impact of DRG payment reform on medical service performance at hospital-wide level. Meanwhile, specific medical and surgical diseases (cerebral infarction and laparoscopic cholecystectomy) were selected for more detailed analysis and the influencing factors of the length of stay and total hospitalization expenses were analyzed meticulously. Relevant information of all insured inpatients of Hospital A from January 2019 to December 2021 was collated. Taking 1st January 2020 as the intervention node, the changes of medical service capability, efficiency, quality and expenses before and after DRG payment reform were studied through the method of interrupted time series analysis (ITSA). Targeting specific medical and surgical patients, the baseline data were adjusted using propensity score matching (PSM) to respectively compare the differences in each evaluation indicator before and after DRG payment reform. Furthermore, the influencing factors on the length of stay and total hospitalization expenses were analyzed using generalized linear regression model. This study found that the hospital-level CMI saw a downward trend but an upward trend in total weight after DRG payment reform, indicating that DRG payment might lead to a decline in medical service capability. Meticulous analysis and purposeful management need to be conducted. Average length of hospital stay at hospital-wide level was shortened conspicuously after DRG payment reform, with the length of hospital stay of both medical and surgical patients shorter significantly than that before the reform, showing that DRG payment can enhance medical service efficiency. The consistency rate of outpatient and inpatient diagnoses was improved and the mortality rate was not changed significantly after DRG payment reform. Compared to those before the reform, there was no significant retrogression in diagnosis consistency, discharge mode, and disease outcomes of medical and surgical patients, inferring that the overall quality of medical service can be guaranteed. Average total hospitalization costs per admission, self-financed expenses per admission, and the proportion of non-medical service income per admission showed a downward trend, while the proportion of self-financed expenses showed an upward trend after DRG payment reform. Moreover, the total costs of specific medical and surgical patients were significantly lower than those before the reform, reflecting that DRG payment can control medical costs to some extent, rationalize cost structure and ease economic burdens for patients. Meanwhile, the influencing factors on the length of stay and total hospitalization costs of medical and surgical patients witnessed some certain differences, among which DRG payment reform, patient age, patient source were common influencing factors. As for surgical patients, clinical pathway management is the key factor influencing both the length of stay and total hospitalization costs, which should be highly concerned by hospitals. Based on the findings above, the study proposes the suggestions that hospitals should clarify their own positions, improve medical capabilities, avoid one-sided pursuit of the decline in average length of hospital stay, and improve supporting policies as well as strengthen refined medical service management under the reform of DRG payment.