医疗保险对中医药发展的影响及对策分析

目的：本研究基于课题前期专家咨询和文献查阅，旨在从定点医疗机构中医医师的视角，进一步分析医疗保险对中医药发展产生的影响，并提出具体建议，以促进中医药与医疗保险的良性发展。方法：采用问卷调查的方法，对全国253 名医疗保险定点医疗机构中医医师在中医药和医疗保险关联方面的看法进行调查研究，使用频数统计等方法对数据进行处理。结果：医保定点后参保患者已成为医院的主要服务人群（73.5%），医院（68.4%）和中医师（41.9%）的收入均有所增长，有助于中医医院做大做强（63.6%）；参保患者主要因疗效（37.9%）和安全（24.1%）而选择中医药治疗，医保报销比例的影响较低（1.2%）；中医药医保报销范围需进一步扩大，如中药院内制剂（90.5%）和代煎费（78.3%）等。结论：在“全民医保”背景下，医疗保险对中医药发展影响越来越大，中医药应通过标准化等手段保障安全和提高疗效，同时医疗保障政策和医疗保险管理服务标准的制定也需考虑中医药的特性，鼓励提供中医药服务。

Influence of Medical Insurance on Development of Traditional Chinese Medicine and Countermeasure Analysis

This study was based on the project prophase of expert consultation and literature consult, and aimed to analyze the medicine establishment from the perspective of traditional Chinese medicine (TCM) doctors, in order to further study the influence of medical insurance on the development of TCM. Detailed suggestions were made in order to promote the benign development trend of TCM and medical insurance. Questionnaire survey was used in the investigation on perceptions of TCM related with medical insurance among 253 TCM doctors in appointed medical institution of medical insurance. Data was processed with frequency statistics. The results showed that after becoming the appointed medical institution of medical insurance, the medical insurance patients have become the main service group (73.5%) of hospitals (68.4%) and incomes of TCM doctors (41.9%) have increased, which contribute to TCM hospitals of becoming bigger and stronger (63.6%). The medical insurance patients have chosen TCM treatment mainly for its curative effect (37.9%) and safety (24.1%). The influence of reimbursement ratio in medical insurance was relatively low (1.2%). The reimbursement range of TCM medical insurance needs to be further expanded, such as Chinese medicine nosocomial preparation (90.5%), decoction preparation fee (78.3%), and etc. It was concluded that under the background of universal health coverage, medical insurance plays a more and more important role in the development of TCM. And TCM should ensure its safety and improve its curative effect through the standardization of TCM and other measures. Meanwhile, the formulation of medical security policy and medical insurance management service standards should also consider the characteristics of TCM, and encourage the service of TCM.