关于医疗机构中药制剂纳入医保支付的思考

Some Thoughts on Incorporating Traditional Chinese Medicine Preparations into Medical Insurance Payment in Medical Institutions

目的:分析医疗机构中药制剂纳入医保基金支付的必要性、现状,提出对策和建议,为促进医疗机构中药制剂健康发展提供参考。方法:从工作实际出发,分析医疗机构中药制剂纳入医保基金支付的重要性,归纳医疗机构中药制剂未纳入医保的原因,并根据国家政策及行业现状提出意见和建议。结果:医疗机构中药制剂纳入医保支付十分重要,但目前缺乏明确的医保支付定价和调价机制,导致医保支付体系不健全。建议要鼓励广大医疗机构积极研发申报中药制剂,合理控制成本并进行价格论证,多部门发力促进医疗机构中药制剂纳入医保支付目录。结论:医疗机构中药制剂纳入医保支付,要运用媒体和公众平台,加强宣传培训,加强部门联动监管,畅通社会监督渠道,开展大数据监管。

Objective:To provide references for the healthy development of TCM preparations in medical institutions by analyzing or offering the necessity,current situation,countermeasures and suggestions of incorporating TCM preparations in medical institutions into medical insurance payment.Method:From the perspective of practical work,the importance of incorporating TCM preparations in medical institutions into the payment of medical insurance fund was analyzed,the reasons for not incorporating TCM preparations in medical institutions into medical insurance were summarized,and opinions and suggestions based on national policies and the current situation of industry were put forward.Results:It is very important to incorporate TCM preparations in medical institutions into medical insurance payment.However,at present the lack of clear pricing and price adjustment mechanism of medical insurance payment leads to the imperfect medical insurance payment system.The majority of medical institutions should be encouraged to actively develop and declare TCM preparations,reasonably control costs and conduct price arguments,and various departments should pull together to promote TCM preparations in medical institutions to be included in the list of medical insurance payment.Conclusion:It is necessary to use the media and public platforms to strengthen publicity and training,enhance united supervision of different departments,unblock the channels of social supervision,and carry out big data supervision so as to ensure that TCM preparations in medical institutions can be incorporated into medical insurance payment.