中医优势病种支付方式改革关键问题及对策  

Key Issues and Countermeasures in the Reform of Payment Methods for TCM Dominant Diseases

作　　者：郝新梅 郭慧君[2] 王亚楠 刘晶[1] Hao Xinmei;Guo Huijun;Wang Yanan(Medical Insurance Management Office,Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing,100091,China;不详)

机构地区：[1]中国中医科学院西苑医院医疗保险管理处,北京100091 [2]中国中医科学院西苑医院统计办公室,北京100091

出　　处：《中国卫生经济》2025年第1期27-33,共7页Chinese Health Economics

基　　金：首都医科大学国家医保研究院开放性课题协议书(YB2023B07);中国中医科学院西苑医院中医药临床科研一体化平台建设专项(XYZX0404-08);国家中医药管理局监测统计中心深化医改中医药政策研究(YGZXKT2024014)。

摘　　要：目的:梳理目前中医医疗机构实施医保支付方式改革面临的问题,并提出改革建议。方法:通过文献分析和实地调研,对部分开展按中医优势病种付费的地市改革实践进行归纳总结。结果:当前中医按病种付费面临很多的问题和困难,如各地开展的中医优势病种数量偏少、中医诊断和操作编码不完善、对中医医疗机构的补偿机制不固定等,影响中医优势病种的开展。结论:中医优势病种付费需要多部门的支持与配合,科学合理地筛选中医优势病种,完善政策、细化管理措施,发挥中医药特色优势。Objective:Sort out the problems currently faced by Traditional Chinese Medicine(TCM) medical institutions in implementing the reform of medical insurance payment methods, and propose reform suggestions.Methods:Through literature analysis and field research, the reform practices of some cities that have implemented payment are summarize based on TCM dominant diseases.Results:Currently, payment by disease for TCM faces many problems and difficulties, such as the small number of dominant diseases of TCM carried out in various regions,the imperfect coding of TCM diagnoses and operations,and the unstable compensation mechanism for TCM medical institutions, which affect the development of dominant diseases of TCM.Conclusion:The payment for TCM dominant diseases requires the support and cooperation of multiple departments,scientifically and reasonably screening TCM dominant diseases,improving policies,refining management measures,and leveraging the unique advantages of traditional Chinese medicine.

关 键 词：中医优势病种 支付方式改革 按病种付费 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.684[经济管理—保险]