目的:探究DIP付费下公立医院病种结构的精细化管理路径，构建区域层面的病种分类管理工具，以清晰刻画医院病种结构与盈亏格局，为管理决策提供实证支撑。方法:基于S市公立医院连续两年的DIP结算数据与医疗收费数据，以DIP-CMI和例均结余为核心指标构建四象限病种矩阵，将全部病种划分为“战略、优势、问题、特殊”四大类，并对各类病种的分布特征、资源消耗及年度演变趋势进行对比分析。结果:研究期内S市总体盈亏病种数量分布相对均衡，超支病种数量略微多于结余病种。矩阵分析显示，当前病种收治结构呈现以优势病种与问题病种占据主导，战略病种与特殊病种收治规模较小。纵向追踪表明，全市病种结构正朝着更加合理、均衡的方向持续优化：盈利区间病例占比稳步提升，低效问题病种的聚集度有效压降，同时高难度特殊病种的超支亏损幅度得到实质性收窄。结论:S市公立医院正处于由规模扩张向内涵建设跨越的关键期。面对医保支付改革，建议医院管理者树立矩阵化管理思维，针对性实施“做强战略病种、稳固优势病种、治理问题病种、纾解特殊病种”的分类管控策略，助推医院高质量发展。

Objective:The paper attempts to explore refined management pathways for the disease group structure of public hospitals under DIP payment, develop a regional classification management tool for disease groups, and provide an evidence-based reference for decision-making. Methods:Based on two consecutive years of DIP settlement and medical charge data in S City, a four-quadrant disease matrix was constructed using DIP-CMI and average balance per case as core indicators. Disease groups were categorized into strategic, advantageous, problematic, and special groups. Their distribution characteristics, resource consumption, and annual evolution trends were comparatively analyzed. Results:During the study period, the overall distribution of surplus and deficit diseases in S City was relatively balanced, with the number of overspending diseases slightly exceeding that of profitable ones. Matrix analysis shows that the current disease structure is dominated by advantageous and problematic diseases, while strategic and special diseases have relatively small admission volumes. Longitudinal tracking indicates that the city’s disease structure is continuously optimizing towards a more rational and balanced direction: the proportion of cases in the profitable range is steadily increasing, the concentration of inefficient problematic diseases has been effectively reduced, and the overspending loss magnitude of high-difficulty special diseases has been substantially narrowed. Conclusion:Public hospitals in S City are in a critical transition period from scale expansion to intensive development. Hospital administrators are advised to adopt matrix thinking and implement differentiated strategies—specifically to "strengthen strategic groups, stabilize advantageous groups, remediate problematic groups, and mitigate special groups"—to drive high-quality hospital development.