摘要
本文通过梳理和分析国家及各地区卫生行政部门发布的中医药医保支付方式改革相关政策,以及报纸报道的各地中医医保支付典型做法,为深化中医药医保支付方式改革提供参考。通过政府网站检索2022年1月15日之前各卫生行政部门发布的“中医药医保支付方式改革”文件及网页上发布的关于“中医医保支付”“中医按病种付费”等新闻,提取需要的信息。总计收集到30个省市有关中医药医保支付方式改革的政策文件及部分地区探索中医优势病种按病种付费的典型做法。目前中医病种实施按病种付费方式主要有单病种付费、按疾病诊断相关分组付费、按病种分值付费和按疗效价值付费;不同类型中医病种的付费方式存在差异;不同的付费方式也存在着相应的问题与难点,建议各地区加强中医药价格调整研究,完善具有中医特色的病种库和手术操作编码体系,健全医疗机构提供适宜中医药服务与医保支付挂钩的正向激励机制。
This paper sorts out and analyzes the relevant policies of medical insurance payment in the field of traditional Chinese medicine issued by the national and regional health administrative departments,as well as the typical practices in various regions reported in newspapers,so as to provide a reference for deepening the reform of medical insurance payment methods in the field of traditional Chinese medicine.Retrieve documents on“reform of traditional Chinese medicine medical insurance payment”issued by various health administrative departments and news on“medical insurance payment of traditional Chinese medicine”and“payment of traditional Chinese medicine by disease type”published on the government website through the government website before January 15,2022,and extract the key information from it.A total of 30 provinces and cities have collected policy documents on traditional Chinese medicine medical insurance payment reform and typical practices in some regions.At present,the payment methods for traditional Chinese medicine diseases mainly include payment by disease,payment by diagnosis related groups,payment by diagnosis-intervention packet,and payment by curative effect value.There are differences in payment methods for different types of traditional Chinese medicine diseases.There are also some problems with different payment methods.It is recommended to strengthen research on price adjustment of traditional Chinese medicine,improve the disease database and surgical operation coding system with traditional Chinese medicine characteristics,and improve the positive incentive mechanism for medical institutions to provide traditional Chinese medicine services and medical insurance payments.
作者
刘黎明
杨雨润
宣天惠
邱佳瑜
李诗麒
满晓玮
蒋艳
赵丽颖
程薇
LIU Liming;YANG Yurun;XUAN Tianhui;QIU Jiayu;LI Shiqi;MAN Xiaowei;JIANG Yan;ZHAO Liying;CHENG Wei(School of Management,Beijing University of Chinese Medicine,Beijing100029,China;Shenzhen Beijing University of Chinese Medicine Research Institute,Guangdong Province,Shenzhen518118,China)
出处
《中国医药导报》
CAS
2023年第12期185-189,共5页
China Medical Herald
基金
北京市卫生健康委员会北京市卫生总费用核算项目(2022cw004)。
关键词
中医药
医保支付方式改革
政策梳理
按病种付费
按病种分值付费
单病种
Chinese medicine
Reform of medicare payment methods
Policy review
Payment by diagnosis related groups
Payment by diagnosis-intervention packet
Single disease payment
