目的: 探讨医保总额预算管理下DRG点数法改革的政策演进、治理逻辑与现实成效。方法: 以柳州为例,系统梳理其2009—2024年医保支付方式改革的路径,基于政策文本分析与内容对比分析法,聚焦2017年与2023年核心政策,系统解析支付机制在预算编制、激励机制与支付模式等方面的演化特征。结果: 医保支付方式改革有助于实现从成本控制向绩效驱动的转型,建成以DRG点数法为主、多元融合的支付体系,有效提升基金使用效率、支付精准度与服务质量导向水平,推动医保制度现代化进程。柳州医保支付方式改革仍存在点值波动控制难度较大、基层激励不足、冲点行为易发等挑战,支付机制运行稳定性有待进一步增强。结论: 本研究为其他地市医保支付方式改革提供了可参考的路径框架。未来改革应注意进一步优化点值调控和绩效考核机制,提升医保对医疗行为与质量的引导效能,实现医保基金安全、质量服务可及与医患满意度提升三者的协同发展。

Objective: The paper explores the policy evolution, governance logic and practical results of DRG point method reform under the total budget management of medical insurance fund. Methods: Based on the policy text analysis and content comparative analysis methods, focusing on the core policies of 2017 and 2023, this paper systematically analyzes the evolution characteristics of the payment mechanism in terms of budget making, incentive mechanism and payment mode. Results: The reform of medical insurance payment method is helpful to realize the transformation from cost control to performance management, build a payment system primarily based on DRG point method and integrating multiple elements, effectively improve the efficiency of fund use, payment accuracy and service quality orientation level, and promote the modernization of medical insurance system. There are still some challenges in the reform of medical insurance payment method in Liuzhou City, such as difficulty in controlling point value fluctuation, insufficient incentive at the grass-roots level, and easy occurrence of excessive points. The stability of payment mechanism needs to be further enhanced. Conclusion: The study provides a replicable path framework for medical insurance payment in prefecture-level cities. In the future, we should further optimize the point value regulation and performance appraisal mechanism, improve the guidance efficiency of medical insurance on medical behavior and quality, and realize the coordinated development of medical insurance fund safety, accessibility high-quality service and doctor-patient satisfaction improvement.