中医优势病种支付方式改革试点经验与启示  

Experience and Enlightenment of the Pilot Reform of Payment Methods for Dominant Diseases of Traditional Chinese Medicine

作　　者：杨菁 李梦滢[2] 沈际勇[2] YANG Jing;LI Mengying;SHEN Jiyong(Zhejiang University School of Medicine,Sir Run Run Shaw Hospital,HangzhouZhejiang310020,China;不详)

机构地区：[1]浙江大学医学院附属邵逸夫医院,浙江杭州310020 [2]清华大学附属北京清华长庚医院/清华大学临床医学院,北京102218

出　　处：《卫生经济研究》2023年第12期33-38,共6页

基　　金：北京清华长庚医院软科学研究基金“基于‘中国医疗服务操作项目分类与编码’的手术科室医师费改革的探索”(32018C0001)。

摘　　要：当前,部分医疗机构和统筹区开展了中医按病种付费的探索,如山东威海的单病种管理、福建泉州的按病种收付费、江苏南京的按病种付费、江西柳州的按疗效价值付费和按优势病种付费等,积累了宝贵的经验。现阶段全国范围内大规模推广中医按病种付费仍面临较多挑战,对此提出建议:建立“国家级-省级-统筹区”三级联动机制,国家医保信息平台应充分考虑中医按病种付费经办服务和基金监管需求,统筹考虑待遇的绝对公平和相对公平,因地制宜推动中医支付方式改革。At present,in some medical institutions and coordinating areas,disease category-based medical insurance payment(DB-MIP)of traditional Chinese medicine has been explored,such as single disease management in Weihai,payment by disease category in Quanzhou and Nanjing,payment by therapeutic value and payment by dominant diseases in Liuzhou,and has achieved positive results.However,there are still many challenges in promoting DB-MIP of traditional Chinese medicine on a large scale nationwide,and suggestions are proposed for this.It is necessary to establish a three-level linkage mechanism of"national level,provincial level,and coordinating area",fully consider the needs of services and fund supervision for DB-MIP of traditional Chinese medicine for the national medical insurance information platform,comprehensively consider the absolute and relative fairness of benefits,and promote the reform of payment methods of traditional Chinese medicine according to local conditions.

关 键 词：中医优势病种 按病种付费 支付方式改革 

分 类 号：R19[医药卫生—卫生事业管理]