通讯作者: 妥宏武, tuohongwu@163.com

DOI：10.12201/bmr.202306.00002

Analysis of the Effect of Traditional Chinese Medicine Medical Insurance Payment by the Diagnosis-Intervention Packet: Based on the Medical Insurance Reform Practice in Liuzhou

• 摘要：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。基于柳州市全市医疗机构住院结算数据,本文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。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支出和检查费用支出增长,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

   

  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 in encouraging TCM medical institutions to actively adopt the TCM method and promoting the development of TCM. Based on the inpatient settlement data of medical institutions in Liuzhou, the paper evaluates the reform of the medical insurance payment method of Liuzhou city for the TCM dominant diseases. The evaluation results showed that: (1)The accessibility of services for strictly selected TCM diseases gradually improved; (2)For degenerative spine changes disease, the cost management of the TCM group was generally better than that of the Western Medicine group, and for lower respiratory tract infectious disease, the cost management of the TCM group needed to be further strengthened; (3)TCM treatment was able to better control the growth of drug expenditures and examination expenses, and patients had a better experience and guaranteed medical safety and quality. Furthermore,This paper also summarized the experience of the TCM disease payment reform in Liuzhou and puts forward policy recommendations to further improve the TCM diagnosis-intervention packet of medical insurance payment reform.

  Key words: traditional Chinese medicine medical insurance payment reform diagnosis-intervention packet; ; 

  提交时间：2023-06-05

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2023-02-17	bmr.202306.00002V1	下载

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