【摘要】 目的：对比分析医保预算下不同等级医院的住院费用结构特征与盈亏风险。方法：采用描述性分析、二元逻辑回归，分析医院的住院费用特征和盈亏风险。结果：一级医院IU29病组病例的住院收入与基金分配最多，例均结余108.33元，二级医院和三级医院例均亏损29.69元和287.49元；各级医院的服务收费弹性和商品收费弹性随住院费用增加呈“先降后升”趋势，三级医院的弹性波动最剧烈，二级医院最稳定；费用结构弹性显著影响病例盈亏状况。结论：优化医保预算管理模式，完善微观分配及动态调整机制；强化医院收入与成本管控，健全全面预算绩效管理机制；建立医保医疗协同治理机制，推动区域医疗资源统筹配置；探索跨系统数据共享模式，创新医保预算控制风险精准识别与预警机制。更多还原

【Abstract】 Objective To compare and analyze the inpatient cost structure characteristics and profit-loss risks of hospitals of different levels under medical insurance budget. Methods Descriptive analysis and binary logistic regression were employed to examine inpatient cost characteristics and profit-loss risks of hospitals. Results Primary hospitals had the highest inpatient revenue and fund allocation for IU29 diagnosis groups, with a mean surplus of 108.33 yuan per case, while secondary and tertiary hospitals had mean deficits of 29.69 yuan and 287.49 yuan per case, respectively. The elasticity of service fee and commodity fee showed a "decrease-then-increase" trend with rising inpatient costs across all hospital levels, with the most significant fluctuation the in tertiary hospitals and the most stability in secondary hospitals. Cost structure elasticity significantly affected the profit-loss status of the cases. Conclusion It is necessary to optimize medical insurance budget management models to refine micro-allocation and dynamic adjustment mechanisms, strengthen hospital revenue and cost control to improve comprehensive budget performance management systems, establish collaborative governance mechanisms between medical insurance and healthcare providers to promote regional resource allocation, and explore cross-system data sharing models to innovate precise risk identification and early warning mechanisms for medical insurance budget control.更多还原