国际健康干预分类体系对中医药医保支付的借鉴意义

Implication of the International Classification of Health Interventions System for TCM Medical Insurance Payment

现阶段以按病种分值付费及按疾病诊断相关分组的医保支付改革正如火如荼地进行。中医药诊疗信息平台不完善、优势病种少、临床路径不规范、中医服务价值低等问题成为中医药医保支付改革的突出矛盾。国际健康干预分类是世界卫生组织研制的用于操作编码的统计系统,旨在为各国提供一套标准的用于健康干预统计、医保支付的信息平台。其完善的分类体系可以为中医药医保支付提供完善的干预信息平台,也将为中医药临床路径的制定、优势病种的遴选、价值的核定提供可靠依据。

At present,the reform of medical insurance payment based on Diagnosis-Intervention Packet and Diagnosis Related Groups is in full swing.The problems of imperfect diagnosis and treatment information platform,few dominant diseases,irregular clinical pathways,and low service value of traditional Chinese medicine(TCM)have become prominent contradictions in the reform of medical insurance payment of TCM.The International Classification of Health Interventions(ICHI)is a statistical system developed by the WHO for operational coding,which aims to provide countries with a set of standard information platforms for health intervention statistics and medical insurance payment.The perfect classification system may provide a perfect intervention information platform for TCM medical insurance payment,and also provide a reliable basis for the formulation of TCM clinical pathways,the selection of dominant diseases and the evaluation of value.