| DRG/DIP付费下中医药医保支付改革的现实困境、典型经验及政策建议 |
| 投稿时间：2024-03-08 点此下载全文
|
| 引用本文：廖藏宜,杨若宁,廖俏敏,任月娟.DRG/DIP付费下中医药医保支付改革的现实困境、典型经验及政策建议[J].中国现代中药,2024,26(5):765-773 |
| DOI：10.13313/j.issn.1673-4890.20240308001 |
| 摘要点击次数: 146 |
| 全文下载次数: 0 |
| 作者中文名 | 作者英文名 | 单位中文名 | 单位英文名 | E-Mail |
| 廖藏宜 |
LIAO Zang-yi |
中国政法大学，北京 100080
广西医科大学，广西 南宁 530000 |
China University of Political Science and Law, Beijing 100080, China
Guangxi Medical University, Nanning 530000, China |
|
| 杨若宁 |
YANG Ruo-ning |
广西医科大学，广西 南宁 530000 |
Guangxi Medical University, Nanning 530000, China |
|
| 廖俏敏 |
LIAO Qiao-min |
崇阳县中医院，湖北 咸宁 437500 |
Chongyang Hospital of Traditional Chinese Medicine, Xianning 437500, China |
|
| 任月娟* |
REN Yue-juan |
大理白族自治州中医医院，云南 大理 671000 |
Dali Bai Autonomous Prefecture Hospital of Traditional Chinese Medicine, Dali 671000, China |
|
|
| 基金项目:国家自然科学基金青年科学基金项目（72004235） |
|
| 中文摘要:中医药是中华民族的传统瑰宝，具有独特诊疗优势和疗效价值。医保支付方式改革要与中医药事业发展协同共进，兼容并蓄发展。基于国家当前正在推进的医保按疾病诊断相关分组（DRG）和按病种分值付费（DIP）付费的改革背景，剖析了中医医保支付面临的困境与挑战，将已经出台了中医倾斜支付政策的滨州、柳州、南京和杭州作为医保倾斜中医支付的典型案例，从病种遴选范围、医疗机构管理制度、费用结算倾斜机制3个方面，对比分析了各自的政策特点与改革经验。单纯的DRG/DIP付费方式改革并不能有效支持中医药传承创新发展的现实问题，各地应基于本地中医药发展实际，因地制宜地打出一套倾斜支付的政策“组合拳”。 |
| 中文关键词:中医药 医保 按疾病诊断相关分组/按病种分值付费 优势病种 |
| |
| Dilemmas, Typical Experiences and Policy Suggestions of TCM Medical Insurance Payment Reform under DRG/DIP Payment |
|
|
| Abstract:Traditional Chinese medicine (TCM) is a traditional treasure of Chinese nation, which has the unique diagnostic and therapeutic advantages of simplicity, low cost, and efficacy. The reform of medical insurance payment methods should be concurrent and inclusive with the development of TCM. Based on the diagnosis related group (DRG)/diagnosis-intervention packet (DIP) payment methodology in healthcare reform proposals currently being promoted by China, this paper analyzed the difficulties and challenges faced by TCM medical insurance payment. Binzhou, Liuzhou, Nanjing, and Hangzhou, which have introduced TCM preferential payment policies, were taken as typical cases. Comparative analysis of their respective policy characteristics and reform experience was conducted from three aspects: disease selection scope, medical institution management system and preferential fee settlement mechanism. The mere adoption of DRG/DIP payment methods does not adequately address the complex challenges associated with the advancement and preservation of TCM. It is requived that regions tailor a comprehensive and context-specific combination of preferential payment policies that favor the development of TCM, reflecting the unique characteristics of their local TCM landscape. |
| keywords:traditional Chinese medicine medical insurance DRG/DIP payment dominant diseases |
|
查看全文
查看/发表评论 下载PDF阅读器 |
|
|
|
