| 引用本文：龚光雯,雷偲,陈曼莉.地方特色中医支付方式改革对中医服务供给的影响基于武汉市“DRG+中医药补偿”模式的案例研究[J].中国卫生政策研究,2025,18(12):32-39 |
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| 地方特色中医支付方式改革对中医服务供给的影响基于武汉市“DRG+中医药补偿”模式的案例研究 |
| 投稿时间：2025-10-31 修订日期：2025-12-02 PDF全文浏览 HTML全文浏览 |
| 龚光雯1,2，雷偲3，陈曼莉1,2 |
| 1.湖北中医药大学管理学院 湖北武汉 430065;2.湖北省高校人文社科研究基地中医药研究发展中心 湖北武汉 430065;3.湖北省中医院 湖北武汉 430061 |
| 摘要:目的 分析武汉市中医支付方式改革对中医服务供给的影响，为构建符合中医特点的支付方式提供依据。方法 采用间断时间序列方法，比较样本医院椎间盘突出患者改革前后服务供给水平、结构和效率的变化。结果 该支付模式未显著改变椎间盘突出患者的住院天数、中医药治疗费用和西药费用，通过减少中医非药物疗法控制了费用的上涨，但存在选择患者和增加中药使用的策略性行为。结论 探索符合中医药特点支付方式的关键在于促进供方提供中医服务获利与医保控费之间的激励相容。可通过将点值加成、系数调整或阈值奖励等精准激励嵌入DRG/DIP支付框架，依据“价值支付”理念构建与中医临床疗效、病例组合指数和服务质量动态关联的考核机制等，推进探索符合中医药特点的支付方式。 |
| 关键词:中医 支付方式 服务供给 DRG 间断时间序列 |
| 基金项目:湖北省自然科学基金中医药创新发展联合基金项目（2025AFD600）；湖北省高校人文社会科学重点研究基地“中医药发展研究中心”一般项目（ZXYB003） |
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| The impact of local TCM medical insurance payment reform on TCM service supply： A case study of the “DRG + TCM compensation” model in Wuhan |
| GONG Guang-wen1,2, LEI Cai3, CHEN Man-li1,2 |
| 1.School of Management， Hubei University of Chinese Medicine， Wuhan Hubei 430065， China;2.Research Center for the Development of Traditional Chinese Medicine， Key Research Base of Humanities and Social Sciences of Hubei Province， Wuhan Hubei 430065， China;3.Hubei Provincial Hospital of Traditional Chinese Medicine， Wuhan Hubei 430061， China |
| Abstract:Objective To analyze the impact of the payment reform for Traditional Chinese Medicine （TCM） in Wuhan on the service provision behaviors of TCM hospitals， and to provide evidence for developing payment methods aligned with the characteristics of TCM.Methods An interrupted time series analysis was conducted to compare changes in the level， structure， and efficiency of service provision for patients with intervertebral disc herniation in sample hospitals before and after the reform.Results The payment model did not significantly alter the length of stay， the proportion of TCM treatment costs， or the proportion of Western medicine costs for these patients. While it controlled cost escalation primarily by reducing the use of non-pharmacological TCM therapies， issues such as "patient exclusiens"and"TCM service exclusions" were observed.Conclusion A payment system tailored to TCM characteristics can achieve incentive compatibility among the objectives of enabling hospital profitability through TCM service provision， controlling medical insurance expenditures， and preserving TCM distinctiveness. Therefore， exploring such payment models should involve embedding precise incentives—such as reasonable point-value bonuses， coefficient adjustments， or threshold-based rewards—into the DRG/DIP payment framework. Furthermore， guided by the "value-based payment" concept， an assessment mechanism dynamically linked to TCM clinical efficacy， case mix index， and service quality should be established to promote the development of TCM-appropriate payment systems. |
| Key words:Traditional Chinese Medicine（TCM） Payment method Services supply Diagnosis-Related Groups （DRG） Interrupted time series |
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