Sorting and analysis of policies related to the reform of traditional Chinese medicine medical insurance payment methods
LIU Liming1 YANG Yurun1 XUAN Tianhui1 QIU Jiayu1 LI Shiqi1 MAN Xiaowei1 JIANG Yan1 ZHAO Liying1 CHENG Wei2
1.School of Management, Beijing University of Chinese Medicine, Beijing 100029, China;
2.Shenzhen Beijing University of Chinese Medicine Research Institute, Guangdong Province, Shenzhen 518118, China
Abstract:This paper sorts out and analyzes the relevant policies of medical insurance payment in the field of traditional Chinese medicine issued by the national and regional health administrative departments, as well as the typical practices in various regions reported in newspapers, so as to provide a reference for deepening the reform of medical insurance payment methods in the field of traditional Chinese medicine. Retrieve documents on “reform of traditional Chinese medicine medical insurance payment” issued by various health administrative departments and news on “medical insurance payment of traditional Chinese medicine” and “payment of traditional Chinese medicine by disease type” published on the government website through the government website before January 15, 2022, and extract the key information from it. A total of 30 provinces and cities have collected policy documents on traditional Chinese medicine medical insurance payment reform and typical practices in some regions. At present, the payment methods for traditional Chinese medicine diseases mainly include payment by disease, payment by diagnosis related groups, payment by diagnosis-intervention packet, and payment by curative effect value. There are differences in payment methods for different types of traditional Chinese medicine diseases. There are also some problems with different payment methods. It is recommended to strengthen research on price adjustment of traditional Chinese medicine, improve the disease database and surgical operation coding system with traditional Chinese medicine characteristics, and improve the positive incentive mechanism for medical institutions to provide traditional Chinese medicine services and medical insurance payments.
刘黎明1 杨雨润1 宣天惠1 邱佳瑜1 李诗麒1 满晓玮1 蒋艳1 赵丽颖1 程薇2. 中医药医保支付方式改革相关政策梳理及分析[J]. 中国医药导报, 2023, 20(12): 185-189.
LIU Liming1 YANG Yurun1 XUAN Tianhui1 QIU Jiayu1 LI Shiqi1 MAN Xiaowei1 JIANG Yan1 ZHAO Liying1 CHENG Wei2. Sorting and analysis of policies related to the reform of traditional Chinese medicine medical insurance payment methods. 中国医药导报, 2023, 20(12): 185-189.