医保付费制度改革背景下中医药非对称共摊机制探索与实践

以DRG/DIP为主导的付费方式是当前支付方式改革的必然趋势,其西医诊断与诊疗体系的核心机制与中医药诊治特点缺乏适配,导致中医药缺乏医保基金补偿的长效机制。针对医保支付与中医药的非对称问题,创新性地引入未充分补偿与非对称共摊的理念,探索适用当前付费制度改革背景下的中医药非对称共摊支持机制,并以此理念指导全面实施DRG且有深厚中医药传统的江苏省常州市,对其中医医疗机构开展非对称共摊相应的系列政策。政策实施后,常州市各中医医疗机构的支付率提升、人均住院费用下降、中医诊疗价值得到有效补偿,达到预期目标,为DRG/DIP付费制度改革背景下有效落实支持中医药可持续发展提供了机制性、系统性卫生政策支撑。

Exploration and Practice of Disproportionate-Share Hospital Payment Mechanism of Traditional Chinese Medicine under the Reform of Medical Insurance Payment System

The payment method dominated by Diagnosis Related Group(DRG)/Big Data Diagnosis-Intervention Packet(DIP) is the inevitable trend of China''s payment method reform, the core mechanism of its western medicine diagnosis system lacks compatibility with the characteristics of TCM diagnosis and treatment, resulting in the lack of a long-term mechanism for medical insurance fund compensation for TCM. Aiming at the disproportionate-share problems between medical insurance payment and TCM, it innovatively introduces the concept of insufficient compensation and disproportionate-share hospital payment abroad. It explores to establish an disproportionate-share hospital payment support mechanism for TCM under the background of current payment system reform. The concept to guiding the full implementation of DRG is explored, while Changzhou City of Jiangsu Province had tradition history of TCM. It carried out a series of corresponding policies for disproportionate-share hospital payment of TCM medical institutions. After the policy is implemented, the payment rate of each TCM medical institution has increased, the per capita hospitalization expenses have decreased, and the value of TCM diagnosis and treatment has been effectively compensated, achieved the desired goal.It provides institutional and systematic health policy support for the effective implementation of support for the sustainable development of TCM in the context of the DRG/DIP payment system reform.