Research on Common Problems and Countermeasures of Hospital Cost Management under DRG Medical Insurance Payment Model

Abstract

This study systematically analyzes the primary challenges and optimization strategies in hospital cost management under the DRG (Diagnosis-Related Groups) medical insurance payment model. The research reveals that the implementation of DRG has fundamentally transformed hospital cost management logic, shifting from per-service billing to a prepaid bundled payment system, which compels hospitals to establish refined cost management frameworks. Current hospital operations face prominent issues including an incomplete cost accounting system, limitations in disease-specific cost calculation, insufficient IT support, and talent shortages. To address these challenges, the study proposes systematic solutions such as strengthening cost awareness, establishing scientific accounting systems, building intelligent control platforms, cultivating interdisciplinary professionals, and exploring diversified control models. These measures will help hospitals achieve cost optimization while ensuring medical quality, adapt to DRG payment reform requirements, and drive their transition from scale expansion to quality-driven efficiency enhancement.