| 引用本文：于淼, 宋琦, 杨燕绥, 妥宏武.中医按病种分值医保付费政策效果分析及经验总结[J].中国卫生政策研究,2023,16(5):34-40 |
|
| 中医按病种分值医保付费政策效果分析及经验总结 |
| 投稿时间：2023-02-17 修订日期：2023-05-08 PDF全文浏览 HTML全文浏览 |
| 于淼1, 宋琦1, 杨燕绥1, 妥宏武2 |
1. 清华大学医院管理研究院 北京 100084;
2. 广州工商学院 广东广州 528138 |
| 摘要:广西柳州市在国内率先形成了依据中医病种结算数据制定的中医病种医保支付标准。这对鼓励中医医疗机构积极采用中医疗法，促进中医药发展具有重要意义。本文基于柳州市全市医疗机构住院结算数据，对柳州市中医优势病种按病种分值付费的医保支付方式改革进行评估。结果显示，经过严格遴选的中医病种的服务可及性逐步提高；对于脊柱退行性改变病种，中医治疗组的成本管理总体优于西医治疗组；对于下呼吸道感染性疾病，中医治疗组的成本管理还有待进一步加强；中医治疗能够较好地控制药费和检查费用的增长，其患者体验较好、医疗安全和质量有保障。本文还总结了柳州市中医病种支付方式改革经验，并提出了进一步完善中医病种分值医保支付改革的政策建议。 |
| 关键词:中医 医保支付方式改革 病种分值付费 |
| 基金项目:国家社会科学基金重大项目(17ZDA121) |
|
| Effect analysis and experience summary of medical insurance payment policy based on disease score of Traditional Chinese Medicine |
| YU Miao1, SONG Qi1, YANG Yan-sui1, TUO Hong-wu2 |
1. Institute for Hospital Management of Tsinghua University, Beijing 100084, China;
2. Guangzhou College of Technology and Business, Guangzhou Guangdong 528138, China |
| Abstract:Liuzhou is the first city in China to form the medical insurance payment standard for Traditional Chinese Medicine (TCM) diseases based on TCM disease settlement data. It is of great significance to encourage TCM medical institutions to actively adopt the TCM therapy and promote the development of TCM. Based on the inpatient settlement data of medical institutions in Liuzhou City, the paper evaluates the reform of the medical insurance payment method for the TCM dominant diseases of traditional Chinese medicine in Liuzhou city based on the disease score. The evaluation results showed that: (1)The accessibility of services for strictly selected TCM diseases is gradually improved; (2)For diseases with degenerative spine changes, the cost management of the TCM treatment group was generally better than that of the Western Medicine treatment group, and for lower respiratory tract infectious disease, the cost management of the TCM treatment group needs to be further strengthened; (3)TCM treatment can better control the increase in drug and examination expenses, and patients experience is better and medical safety and quality are guaranteed. Furthermore, this paper summarizes the experience of the TCM disease payment reform in Liuzhou and puts forward policy suggestions to further improve the reform of medical insurance payment for TCM diseases. |
| Key words:Traditional Chinese Medicine Medical insurance payment reform Payment policy based on disease score |
| 摘要点击次数: 826 全文下载次数: 386 |
|
|
|
|
|
