Objectives: This study analyzes the medical insurance balance of a hematology specialized hospital under DRG payment reform and explores the influencing factors, providing scientific basis for hospitals to better adapt to DRG payment policies and promote refined management. Methods: The paper collects data of cases paid by DRG from a first-class hematology specialized hospital from October 2022 to July 2023, and uses binary logistic regression analysis to analyze the influencing factors of medical insurance balance level. Results: A total of 4018 cases were included in the study, and the analysis of influencing factors shows that there are differences in DRG medical insurance balance levels among cases with different enrollment cases, disease groups, presence or absence of comorbidities/complications, classification of procedures, age, and medical insurance type (P<0.05). Conclusions: Under DRG payment, medical institutions should allocate resources reasonably, optimize cost structure, strengthen monitoring of difficult and severe cases with high cost, reasonably control costs, and improve the level of refined management.