目的: 分析A市DRG付费下市域基础组与县域基层组同病同价政策的运行特征。方法: 基于2024—2025年DRG目录、住院医保结算清单和医疗机构信息,比较政策组与常规组的目录结构、资源消耗、机构承接、费用离散度及“支付标准–费用差额”。结果: 市域基础组覆盖更广,县域基层组更集中于低权重内科病组。两类政策组资源消耗下降、费用离散度低于常规组,但承接层级变化有限;市域基础组主要由三级机构承接,且“支付标准–费用差额”持续为负。结论: 同病同价政策短期变化主要体现为资源消耗收敛和院内行为调整,单一价格杠杆难以推动病例下沉。应分类优化目录、完善转诊衔接、动态校准支付标准,并强化费用与质量协同监管。

Objective: The paper analyzes the operational characteristics of the “same disease, same price” policy under the DRG payment in A City, as implemented through the urban basic group and the county-level primary group. Methods: Using 2024-2025 DRG catalog data, inpatient medical insurance settlement records, and healthcare institution information, we compared the policy groups with the conventional group across five dimensions: catalog structure, resource consumption, institutional undertaking, cost dispersion, and the "payment standard-cost margin". Results: The urban basic group covered a broader range of DRG, while the county-level primary group was more concentrated in low-weight internal medicine DRG. Both policy groups showed reduced resource consumption and lower cost dispersion compared with the conventional group, but changes in the tier of institutional undertaking remained limited. The urban basic group was predominantly undertaken by tertiary institutions, with a persistently negative "payment standard-cost margin". Conclusion: In the short term, the “same disease, same price” policy primarily manifests as resource consumption convergence and intra-hospital behavioral adjustments, and a single price lever is insufficient to drive patient shifting to lower-level institutions. Policy optimization should focus on catalog refinement by category, referral pathway enhancement, dynamic payment standard calibration, and strengthened coordinated supervision of both costs and quality.