我国县级中医药发展的现状和策略

Traditional Chinese Medicine at the county-level in China: An analysis of the status quo and development strategies

目的:分析县中医院和县综合医院业务变化趋势,为县级中医药发展提供政策参考。方法:利用1993—2010年全国所有县中医院执业医师人员数、县级医院医师服务量和收入数据,进行描述性分析。结果:1993—2010年,县中医院院均中医执业医师构成比从62.5%下降到38.3%;县中医院的每医师日均门急诊人次数、县中医院和县综合医院每医师日均住院床日数均呈现先降低后增长趋势,而县综合医院每医师日均门急诊人次数持续增长;县中医院门诊和住院中药收入分别仅占其药品收入的35.0%～40.9%和10.8%～14.2%。结论:县中医院中医人力资源减少,医师服务效率低于县综合医院,收入结构趋近于县综合医院,中药收入少于西药。县中医院仍体现门诊服务优势,而县综合医院体现住院服务优势。建议:建立有效的中医人才激励机制,加强中医人才队伍建设,调整中医药服务价格尤其是门诊服务价格,新农合在分病种的基础上加强补偿中医药门诊服务。

Objective： To compare the operation trend between Traditional Chinese Medicine （TCM） and general hospitals. Methods： We carried out descriptive analysis of human resources, health services delivery, and income re- ported nationwide from 1993 to 2010. Results： During these years, the percentage of TCM physicians practicing in country TCM hospitals decreased from 62. 5% to 38.3% ; the daily number of inpatients and outpatients per doctor in county TCM hospitals decreased; the daily number of inpatients per doctor decreased in county hospitals, but grew in county general hospitals. Herbal medicine respectively accounted for 35.0% to 40. 9% and 10. 8% to 14. 2% of outpa- tient and inpatient medication income in county TCM hospitals. Conclusions ： From 2003 to 2010, county TCM hospitals had less TCM human resources than before and were less efficient than county general hospitals. The breakdown of rev- enue for TCM and general hospitals gradually became similar, and herbal medicines accounted for a lesser proportion of revenue than western medicine. However, county TCM hospitals prioritized outpatient services, and county general hos- pitals prioritized inpatient services. Suggestions ： We suggest creating incentives for TCM physicians, training TCM phy- sicians, reducing tient services by the cost of TCM services （especially outpatient services）, and expanding the coverage of TCM outpa- classifying diseases in the New Rural Cooperative Medical Scheme