Objective: This study attempts to construct a model of hospitals’ medical insurance revenue and expenditure influencing factors to provide reference for the management of medical expenses and control of medical costs in medical institutions under the DIP payment method reform. Method: We collect data of actual cases paid by DIP from a tertiary hospital in Chifeng City from November 2021 to June 2022, and apply a multiple linear regression model to analyze the influencing factors of the hospital's medical insurance balance level. Results: A total of 33534 cases were included in this study. The hospital’s medical insurance revenue and expenditure balance was positively correlated with age, medical insurance type, cost deviation category, disease severity, surgical treatment status, proportion of consumable expenses, and proportion of treatment expenses of patients (p<0.001). The proportion of drug expenses, types of diseases, and length of stay are negatively correlated with the hospital’s medical insurance balance (p<0.001). Conclusion: Under the DIP payment, medical institutions should focus on controlling the cost of diagnosis and treatment as well as drugs and consumables, controlling cases of cost deviation, and improving the hospital's medical insurance balance. The medical insurance department should continuously improve the DIP payment operation mechanism, balance the differences in medical insurance payment for cases with different identities, ensure accurate payment for critically ill cases, and correctly guide medical institutions to strengthen management.