目的: 分析按照主要诊断类别（MDC）分组的DRG付费结果,为医疗机构优化病种收治结构和医保基金精细化管理提供借鉴。方法: 获取山东省某三级医院2022年纳入DRG付费病例的病案首页、分组结果、医保结算以及DRG付费数据,采取描述性统计分析,对DRG病组按照MDC分组的付费结果进行分析。结果: 2022年该院DRG付费144158例,分布在26个MDC组,病例数前三位分别是MDCR、MDCB和MDCF。平均权重高于理论权重的有14组,占比53.85%;低于理论权重的有12组,占比46.15%。支付率前三位分别是MDCY、MDCR、MDCI （140.56%、124.83%、119.85%）;支付率后三位分别是MDCA、MDCW、MDCO （75.53%、75.92%、78.04%）。病例按照MDC分组在费用分布、权重以及付费结果等方面存在一定差异。结论: 医院收治病种分布与疾病MDC分组的发病率以及学科发展情况有关,分析病种MDC分组可以为医疗机构病种结构调整和医保支付政策优化提供依据。

Objective: The paper analyzes the DRG payment results grouped according to the main diagnosis categories (MDC), and provides reference for the optimization of the disease structure of medical institutions and their refined management of medical insurance funds. Methods: The first page of medical records, grouping results, medical insurance settlement and DRG payment data of cases paid by DRG in a large tertiary general hospital of Shandong Province in 2022 was obtained, and the payment results of DRG by MDC were analyzed by descriptive statistics. Results: In 2022, a total of 144158 cases paid by DRG was distributed in 26 MDCs, among which the top three were MDCR, MDCB and MDCF. There were 14 MDCs whose average weight was higher than the theoretical weight, accounting for 53.85%, and 12 MDCs whose average weight was lower than the theoretical weight, accounting for 46.15%. In terms of payment rate, the top three were MDCY, MDCR and MDCI (140.56%, 124.83% and 119.85%), and the last three were MDCA, MDCW and MDCO (75.53%, 75.92% and 78.04%). There were differences in cost distribution, weight and payment results of cases grouped according to MDC. Conclusion: The distribution of diseases admitted by hospitals is related to the incidence of disease in each MDC and the development of hospital disciplines. The analysis of MDC can provide a basis for adjusting the disease structure of medical institutions and optimizing medical insurance payment policies.