“循证+价值”驱动下的中医药医保支付制度创新  

Innovation of Traditional Chinese Medicine Insurance Payment System Drived by the “Evidence-Based and Value” Theory

作　　者：郭丹丹[1] 苏宇[1] 彭凯[1] 余海洋 张亮[1] 熊巨洋[1] 

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]国家中医药管理局,北京100027

出　　处：《中国卫生经济》2016年第8期33-34,共2页Chinese Health Economics

基　　金：国家中医药管理局项目"完善中医药事业发展政策与机制研究"(A-003);华中科技大学人文社科重点项目(0118516045)

摘　　要：目的:探讨适合中医药特点的医保支付方式,为完善中医药医保支付制度提供依据。方法:采取实地调研与文献研究相结合的方法,分析目前医疗机构所采取的按项目付费、按病种付费及总额预付方式对中医服务的利用及中医药事业发展的影响。结果:我国目前的医保支付方式并不符合中医药的特点,其在一定程度上制约了中医药特色及优势的发挥。结论:基于"循证+价值"的观点,提出总额预付和按病种付费结合的符合中医药发展规律的中医药医保制度。Objective： To explore the medical insurance payment suitahle for the characteristics of Traditional Chinese Medi- cine（TCM）, provide the basis for perfecting TCM health care payment system. Methods： Field study and literatnre research were ap- plied to analyze the influence of fee for service（FFS）, diagnosis related groups（DRGs） and glohal budget on the utilization of TCM and the development of TCM industry. Results： The current medical payment method was not suitable for the characteristics of TCM, which restricted the features and advantages of TCM to some extent. Conclusion： Based on the view of ＂evidence-based and val- ue＂ , it put forward a TCM medical insurance system combined with global budget and DRGs which was suitable for TCM develop- ment regulation.

关 键 词：中医药 医保制度 支付方式 循证 价值 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]