中医优势病种按疗效价值付费改革效果分析  

Analysis of the Effect of the Payment Reform according to the Value of Efficacy for Dominant Diseases in Traditional Chinese Medicine

作　　者：于伟 李佳宁 钟璐 黄伟 叶子轶 李昀梦 曾雪琴 YU Wei;LI Jianing;ZHONG Lu;HUANG Wei;YE Ziyi;LI Yunmeng;ZENG Xueqin(The Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China;不详)

机构地区：[1]西南医科大学附属医院,四川泸州646000 [2]蓬安县中医医院,四川南充637800 [3]泸州市医疗保障事务中心,四川泸州646000 [4]西南医科大学,四川泸州646000 [5]营山县中医医院,四川南充637700

出　　处：《卫生经济研究》2025年第4期23-27,共5页

基　　金：四川中医药文化协同发展研究中心“新质生产力驱动下中医药传承创新与高质量发展实践与组态路径研究”(2024XT037);四川医院管理和发展研究中心“基于DIP基层病种的分级诊疗实践路径及效果分析”(SCYG2024-26);四川中医药发展研究中心“高质量发展视域下泸州中医药文化产业助力乡村振兴路径研究”(DJKYB202323);南充市社科规划项目“川北健康人文研究”专项课题“价值医疗视角下中医优势病种评价标准及实践研究”(NC24CB12)。

摘　　要：目的:分析中医优势病种按疗效价值付费改革效果,为改革向纵深推进提供参考。方法:采用双重差分模型(DID),对泸州市10个按疗效价值付费的中医优势病种,从资源消耗、费用结构等方面分析中医治疗组(干预组)与手术治疗组(对照组)在改革前后的差异。结果:改革后试点病种采用中医治疗的比例从66.09%提高至71.74%,中医治疗组次均费用、自付费用远低于手术治疗组;除4个指标外,其余指标的DID交互系数均有统计学意义;试点病种的医保结算均处于盈余状态,有8个病种的医保结余空间均为正。结论:中医优势病种按疗效价值付费能够提高中医治疗比例、减轻患者费用负担、提高医疗机构盈余水平、节省医保基金支出;建议逐步扩大试点病种和试点医疗机构范围,完善试点病种临床路径,加强监管与评估,动态调整试点病种支付标准,实现医患保多方共赢。Objective To analyze the effect of the payment reform according to the value of efficacy for dominant diseases in traditional Chinese medicine,and to provide reference for the reform to be pushed forward in depth.Methods Using the double difference model(DID)method,the differences in resource consumption and cost structure between the TCM group(intervention group)and the surgical treatment group(control group)before and after the reform were analyzed for 10 dominant diseases in traditional Chinese medicine paid according to their value of efficacy in Luzhou City.Results The proportion of pilot diseases treated with TCM increased from 66.09%to 71.74%after the reform,and the sub-average cost and out-of-pocket expenses of the TCM treatment group were much lower than those of the surgical treatment group.Except for the four indicators,the DID interaction coefficients of the other indicators were statistically significant.The medical insurance settlements of the pilot diseases were in a surplus state,and the space of the balance of the medical insurance of eight diseases were all positive.Conclusion The payment reform according to the value of efficacy for dominant diseases in traditional Chinese medicine can increase the proportion of TCM treatment,reduce the cost burden of patients,improve the surplus level of medical institutions,and save the expenditure of medical insurance funds.It is recommended to gradually expand the scope of pilot diseases and pilot medical institutions,improve the clinical pathway of pilot diseases,strengthen the supervision and evaluation,and dynamically adjust the pilot disease payment standard,so as to realize the win-win situation for doctors,patients and insurers.

关 键 词：中医优势病种 按疗效价值付费 按病种付费 

分 类 号：R197[医药卫生—卫生事业管理]