首页|中医优势病种DRG付费:政策、难点及对策

中医优势病种DRG付费:政策、难点及对策

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目的:分析各地中医优势病种DRG付费政策,为推进医保支付方式改革提供实证参考.方法:通过政策梳理和案例研究,分析中医DRG付费政策的实施成效及难点,提出对策建议.结果:各地中医DRG付费政策差异较大,存在中医优势病种概念不明、基层医疗机构覆盖不足、治疗质量考核规则不统一、病种遴选机制有待完善、医保-医院协同有待加强等难点.结论:加强部门协同,鼓励医院深度参与中医DRG付费;扩大政策覆盖范围,加大基层倾斜力度;精准界定中医优势病种,完善质量考核规则.
DRG Payment for Dominant Diseases of Traditional Chinese Medicine:Policies,Difficulties and Countermeasures
Objective To analyze the payment policies of DRG for dominant diseases of traditional Chinese medicine in various places,and to provide empirical reference for promoting the reform of medical insurance payment methods.Methods Through literature analysis and case study,the implementation effect and difficulties of DRG payment policies in traditional Chinese medicine were analyzed,and countermeasures and suggestions were put forward.Results There were significant differences in the DRG payment policies for traditional Chinese medicine among different regions.There were difficulties such as unclear concepts of dominant diseases in traditional Chinese medicine,insufficient coverage of primary medical institutions,inconsistent assessment rules for treatment quality,incomplete disease se-lection mechanisms,and the need to strengthen the collaboration between medical insurance and hospitals.Conclusion It is necessary to strengthen departmental cooperation and encourage hospitals to deeply participate in the DRG payment of traditional Chinese medicine,ex-pand the policy coverage and intensify the tilt towards primary level,and accurately define the dominant diseases of traditional Chinese medicine and improve the quality assessment rules.

dominant diseases of traditional Chinese medicinetraditional Chinese medicine DRG paymentreform of medical insurance payment method

李希、邓世虎、彭美华、吴靖文、周望苏、余丽君

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成都中医药大学管理学院,四川成都 611137

四川省眉山市医疗保障局,四川眉山 620020

中医优势病种 中医DRG付费 医保支付方式改革

2025

卫生经济研究
华东卫生经济研究协作会

卫生经济研究

北大核心
影响因子:1.01
ISSN:1004-7778
年,卷(期):2025.42(1)