“循证+价值”驱动下的中医药医保支付制度创新

Innovation of Traditional Chinese Medicine Insurance Payment System Drived by the “Evidence-Based and Value” Theory

目的:探讨适合中医药特点的医保支付方式,为完善中医药医保支付制度提供依据。方法:采取实地调研与文献研究相结合的方法,分析目前医疗机构所采取的按项目付费、按病种付费及总额预付方式对中医服务的利用及中医药事业发展的影响。结果:我国目前的医保支付方式并不符合中医药的特点,其在一定程度上制约了中医药特色及优势的发挥。结论:基于"循证+价值"的观点,提出总额预付和按病种付费结合的符合中医药发展规律的中医药医保制度。

Objective： To explore the medical insurance payment suitahle for the characteristics of Traditional Chinese Medi- cine（TCM）, provide the basis for perfecting TCM health care payment system. Methods： Field study and literatnre research were ap- plied to analyze the influence of fee for service（FFS）, diagnosis related groups（DRGs） and glohal budget on the utilization of TCM and the development of TCM industry. Results： The current medical payment method was not suitable for the characteristics of TCM, which restricted the features and advantages of TCM to some extent. Conclusion： Based on the view of ＂evidence-based and val- ue＂ , it put forward a TCM medical insurance system combined with global budget and DRGs which was suitable for TCM develop- ment regulation.