中医药医保政策的三维审视分析——基于政策工具、政策议题与政策力度

A Three-Dimensional Analysis of Traditional Chinese Medicine Medical Insurance Policies——Analysis Based on Instruments,Issues,and Intensity of Policy

目的:通过对当前中医药医保相关政策文本进行研究,分析近五年我国中医药医保类政策文本的情况,为完善中医药医保政策提供相应的建议。方法:在相关政府官方网站及北大法宝检索近五年中央和地方层面的中医药医保支付相关政策文本,运用NVivo软件对政策文本进行分析,构建“政策工具—政策议题—政策力度”三维分析框架。结果:中医药医保相关政策中供给型、环境型、需求型政策工具使用占比分别为50.00%、35.98%、14.02%;平均政策力度分别是3.31、2.98、3.22。中医药服务的质量评价和监管的医保支付政策力度最大,政策力度最低的是中医药服务的医保定点机构管理。结论:我国中医药医保相关政策存在政策工具内部结构不平衡和政策议题、政策工具与政策力度综合使用不平衡的问题。为此,建议在中医药医保政策中充分考虑中医药的服务模式和治疗特点,加强政策宣传,促进部门间协同,适度调整政策力度,以确保政策支持既充分又可持续。

Objective:The paper analyses the policy texts of traditional Chinese medicine(TCM)medical insurancein the past five years by studying the current policy texts related to TCM medical insurance,so as to provide suggestions for improving TCM medical insurance policies.Methods:The policy texts related to TCM medical insurance payment in the past five years were retrieved from the official websites of relevant government departments and PKULAW,and the policy texts were analyzed by NVivo software,constructing a three-dimensional analytical framework of"policy instruments-policy issues-policy intensity".Results:The proportion of supply-type,environment-type,and demand-type policy tools used in policies related to TCM medical insurance was 50.00%,35.98%,and 14.02%,respectively,while the average of policy strengths were 3.31,2.90,and 3.20,respectively.The quality evaluation and regulation of TCM services is the strongest in medical insurance payment,while the management of TCM medical insurance designated institutions is the lowest.Conclusion:There is an internal structural imbalance and a comprehensive use imbalance of policy issues,instrument,and intensity in polices related to TCM medical insurance.It is recommended that we should fully consider the service mode and treatment characteristics of TCM in the medical insurance policy,strengthen policy promotion,promote collaboration between departments,and adjust policy intensity appropriately to ensure that policy support is both sufficient and sustainable.