按病种付费是当前推进医疗体制改革的重要举措之一。本研究以慢粒疾病为例考察按病种付费的可行性并探究其对医疗机构管理带来的可能影响。采用回顾性数据分析法及病历调查法研究了中国医学科学院血液病医院2011-2015年的慢粒髓细胞白血病门诊及住院病历数据,依据相关病例的特征,得出该疾病的10组平均费用。研究发现回顾性数据平均费用可作为医保支付的预算及考核,不能直接作为患者的支付价格。简单的平均费用数值不能反映复杂的疾病发生特性,也与临床推行的规范诊疗路径要求相违背,不易让临床医生接受。易出现患者入组率低和拒收重症患者的副作用,需要建立更合理的病种定价方法,以期解决医保支付问题的同时有助于医疗质量管理。 Payment by disease is one of the important measures to promote the reform of the medical system at present. In this study, taking CAG as an example, we investigated the feasibility of payment by disease type and explored its possible impact on the management of medical institutions. The retrospective data analysis and medical records were used to study the data of outpatient and hospitalized patients with chronic myeloid leukemia from 2011 to 2015 in the Hematology Hospital of Chinese Academy of Medical Sciences. Based on the characteristics of the relevant cases, the average cost of the 10 groups of patients was obtained. The study found that the average cost of retrospective data can be used as a budget and assessment of medical insurance payments, can not be directly as the patient’s payment price. Simple average cost value does not reflect the complex characteristics of the disease, but also with the implementation of clinical norms clinic path requirements contrary to the law, not easy for clinicians to accept. Prone to low enrollment rate of patients and reject the serious side effects of critically ill patients need to establish a more reasonable pricing of disease types in order to solve the problem of medical insurance payments while contributing to medical quality management.