基于临床路径按中医特色病种付费试点改革研究

Research on Pilot Reform of Payment According to TCM Characteristic Diseases Based on Clinical Pathway

目的实行按中医特色病种付费试点改革,有助于完善医保支付制度改革,优化中医医疗服务的资源配置。方法通过南京市按中医特色病种付费的可行性分析,从病种选择、疾病编码、支付标准探索按中医特色病种付费的实施途径。结论按中医特色病种付费试点改革需要在中医特色病种优势发挥、按病种付费支付明确和中医临床路径执行规范的基础上,完善中医诊疗项目收费标准,稳步推进医保支付制度改革,助推中医药传承与创新发展。

Objective To carry out the pilot reform of payment according to the characteristic diseases of Traditional Chinese Medicine(TCM),which is helpful to perfect the reform of medical insurance payment system and promote the resource allocation and scientific use of TCM medical service.Methods By analyzing the feasibility of paying according to the characteristic diseases of TCM in Nanjing,we explored the way of paying according to the characteristic diseases of TCM from the selection of diseases,disease coding and payment standard.Conclusion On the basis of the advantages of the characteristics diseases of TCM,the clear payment according to the disease,and the implementation of the standard of the clinical pathway of TCM,the pilot reform of payment according to the characteristics diseases of TCM needs toimprove the charging standards of TCM diagnosis and treatment items,steadily promote the reform of the medical insurance payment system,and promote the inheritance and innovation development of TCM.