大型公立医院由2002—2022年的高速发展，实现了学科、人才、教学量的积累提升，优秀的公立医院建立起了学科优势品牌、完成了人才储备。但近年来大型公立综合医院面临着宏观政策环境、内部管理环境的巨大变化压力。私立医院的崛起，市场竞争加剧。由前期量的积累所产生的虹吸效应逐步减弱。大型综合医院面临着支付方式改革、公共医疗任务承担等各方面压力。"一院多区"的经营模式对于促进地区医疗水平有着积极意义，但对医院的运营管理提出了较大挑战。中国公立医院必然由粗放型管理向高质量精细化管理转型，成本管理是精细化医院管理的着力点，公立医院开始探索建立实用、高效的按病种付费成本管理体系，为医院高质量持续性发展提供管理支持。

From 2002 to 2022, the rapid development of large public hospitals has achieved the accumulation and improvement of disciplines, talents and teaching volume. Excellent public hospitals have established a discipline advantage brand and completed the talent reserve. However, in recent years, large public general hospitals are facing great pressure from macro policy environment and internal management environment. With the rise of private hospitals, market competition is intensifying. The siphon effect produced by the accumulation of the previous amount gradually diminishes. Large general hospitals are facing pressure from various aspects such as payment reform and public medical task undertaking. The business model of "one hospital and multiple districts" has a positive significance for promoting the regional medical level, but poses a great challenge to the operation and management of the hospital. China's public hospitals are inevitably transitioning from extensive management to high-quality and refined management. Cost management is the focus of good hospital management. Public hospitals have begun to explore the establishment of a practical and efficient case-based payment cost management system, so as to provide management support for the high-quality and sustainable development of hospitals.