医保DRG/DIP支付改革下中医优势病种应用现状  

Application status of DRG/DIP medical insurance payment reform in dominant diseases treated by traditional Chinese medicine

作　　者：张敬华[1] 杨若宁 叶丹 任晓虹 周宁 ZHANG Jinghua;YANG Ruoning;YE Dan;REN Xiaohong;ZHOU Ning(Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing Jiangsu 210022,China;Guangxi Medical University,Nanning Guangxi 530022,China)

机构地区：[1]南京中医药大学附属南京中医院,江苏南京210022 [2]广西医科大学,广西南宁530022

出　　处：《卫生软科学》2024年第8期4-6,共3页Soft Science of Health

基　　金：南京市中医药青年人才培养计划(ZYQ20004);江苏省级卫生健康经济管理研究课题项目(CW202336);江苏省科学技术协会调研课题(JSKXKT2024026);江苏省医院管理创新研究课题(JSYGY-3-2024-27)。

摘　　要：基于DRG/DIP支付改革的历史背景,分析我国各省(市)中医优势病种的应用现状。中医优势病种因中医医疗机构所在区域、级别、优势重点专科上的差异而呈现不同的分布特征。中医优势病种的遴选有3种方式:①通过省级中医药主管部门选取;②医疗机构、卫健、医保三方联合商定选取;③基于全省的历史数据测算并通过中医专家论证确立。中医优势病种支付制度为单病种、DRG、DIP 3种类型结合的“组合拳”式制度设计,其应用在一定程度上减轻了患者疾病经济负担、激励了医院控本增效、提升了医保基金使用效率,但目前尚存在中医疾病分类代码标准未统一、中医优势病种临床路径建设及临床循证有待加强、支付制度对医患双方激励性仍欠缺等问题。Based on the historical background of DRG/DIP payment reform,this paper analyzes the application in dominant diseases treated by TCM in various provinces(municipalities)in China.The dominant diseases treated by TCM show different distribution characteristics due to the differences in the regions,levels and key specialties of TCM medical institutions.There are three ways to select the dominant diseases treated by TCM:①through the provincial administrations of Chinese medicine,②joint selection by medical institutions,health commissions and medical insurance bureau,③calculation based on the historical data of the province and argumentation of Chinese medicine experts.The payment system of dominant diseases treated by TCM is designed as a combination system including single diseases,DRG and DIP.Its application has reduced the economic burden of patients to a certain extent,encouraged hospitals to control cost and increase efficiency,and improved the use efficiency of medical insurance funds.However,there are still some problems,such as the ununified code of TCM classification of diseases,further development of the construction of clinical pathways for dominant diseases treated by TCM and evidence-based clinical practice,and the lack of incentive of payment system for both doctors and patients.

关 键 词：中医优势病种 DRG 中医药 

分 类 号：R19-0[医药卫生—卫生事业管理]