目的：探讨按病种付费对医疗机构提高控费意识，规范医疗行为，减少不合理医药费用，降低患者的医疗经济负担和按病种付费的执行初期暴露的问题。方法：对该院2015年按病种付费超支情况进行了原因分析，并通过政策宣讲、规范收费、规范治疗方案等方法控制过度医疗行为。结果：经过以上措施的落实，2016全年参与按病种付费的病案总体结算未超支。结论：科学合理的医保管理有利于在保证医疗安全的同时做到医疗费用的控制。
Objective：To discuss problems in improving medical institutes’ awareness of controlling costs, standardizing clinical behavior, reducing unreasonable medical cost, and reducing patients’ economic burden during initial implement of Diseases Related to Groups. It exposed many problems in the beginning of carrying out DRGs in hospitals. Methods：This paper analyzes the causes of overspending according to DRGs in our hospital in 2015，and managed to control excessive medical behavior by means of policy advocacy，standardization of fees，and regulation of treatment schemes. Results：after the implementation of the above measures，total settlement of medical records paid by DRGs for the full year 2016 without overrun. Conclusion：Scientific and reasonable medical insurance management is beneficial to ensure medical safety and keep medical expenses under control at the same time.