推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下...推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下中医院的诊疗行为策略选择及其影响因素。结果表明,在按项目支付下中医院会选择过度诊疗的行为策略以谋取更多的利润;在DRG支付下,中医院会从过度诊疗的行为向缩减诊疗的行为转化,最终选择缩减诊疗的行为策略以获得更大的利润。这表明,与现行的支付方式相比,DRG支付可以在一定程度上纠正中医医疗机构的过度诊疗行为,遏制医疗资源的浪费,但仍需充分发掘中医药的适宜技术和优势病种,发挥中医药的独特优势,实现中西医之间的优势互补。展开更多
Traditional Chinese Medicine(TCM), based on the philosophic idea of “correlation between man and nature” and “balance of Yin and Yang” and characterized by “integrated concept” and “syndrome identification &...Traditional Chinese Medicine(TCM), based on the philosophic idea of “correlation between man and nature” and “balance of Yin and Yang” and characterized by “integrated concept” and “syndrome identification & treatment determination”, adjusts and activates the self-recuperating ability to rectify its differentiation from normality of human body to meet the goal of preventing and treating diseases mainly by means of traditional Chinese medicinal herbs, acupuncture and moxibustion, etc. The idea of “Human should be in harmony with Nature including bacterium, virus, etc., but not to exterminate microbe in a large scale”, held and promoted by TCM gives, rise to a delicate physiological equilibrium kept between man and microbe and this is just the development trend of medical science in future. For thousands years, TCM has made indelible contribution to the reproduction and prosperity of the Chinese nation, and under the countless attacks of pestilence has never made its people’s death in millions, not such as once occurred in Europe. TCM is also characterized by its “simple, convenient, cheap and effective”method of treatment” and is especially good at preventing and treating chronic diseases, complicate multi-system diseases and new-type virus diseases. Therefore, only when the sanitation and healthcare system is established can the health of 13 billion people in China and the problem of shortage of doctor and medicine for 900 million rural population and large number of poverty-stricken urban population be solved. It is strongly suggested that five promotion projects, namely: TCM policy and statute guarantee, TCM qualified personnel cultivation, TCM scientific research, development of TCM in rural areas and TCM administrative system reform should be carried out in real earnest to make TCM develop in a sustainable way.展开更多
文摘推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下中医院的诊疗行为策略选择及其影响因素。结果表明,在按项目支付下中医院会选择过度诊疗的行为策略以谋取更多的利润;在DRG支付下,中医院会从过度诊疗的行为向缩减诊疗的行为转化,最终选择缩减诊疗的行为策略以获得更大的利润。这表明,与现行的支付方式相比,DRG支付可以在一定程度上纠正中医医疗机构的过度诊疗行为,遏制医疗资源的浪费,但仍需充分发掘中医药的适宜技术和优势病种,发挥中医药的独特优势,实现中西医之间的优势互补。
文摘Traditional Chinese Medicine(TCM), based on the philosophic idea of “correlation between man and nature” and “balance of Yin and Yang” and characterized by “integrated concept” and “syndrome identification & treatment determination”, adjusts and activates the self-recuperating ability to rectify its differentiation from normality of human body to meet the goal of preventing and treating diseases mainly by means of traditional Chinese medicinal herbs, acupuncture and moxibustion, etc. The idea of “Human should be in harmony with Nature including bacterium, virus, etc., but not to exterminate microbe in a large scale”, held and promoted by TCM gives, rise to a delicate physiological equilibrium kept between man and microbe and this is just the development trend of medical science in future. For thousands years, TCM has made indelible contribution to the reproduction and prosperity of the Chinese nation, and under the countless attacks of pestilence has never made its people’s death in millions, not such as once occurred in Europe. TCM is also characterized by its “simple, convenient, cheap and effective”method of treatment” and is especially good at preventing and treating chronic diseases, complicate multi-system diseases and new-type virus diseases. Therefore, only when the sanitation and healthcare system is established can the health of 13 billion people in China and the problem of shortage of doctor and medicine for 900 million rural population and large number of poverty-stricken urban population be solved. It is strongly suggested that five promotion projects, namely: TCM policy and statute guarantee, TCM qualified personnel cultivation, TCM scientific research, development of TCM in rural areas and TCM administrative system reform should be carried out in real earnest to make TCM develop in a sustainable way.
