中医药在治疗慢性病、预防疾病、促进康复等方面具有独特优势,合理的医保付费制度可促进中医药发展。目前的按项目付费、DRG/DIP付费等医保支付方式具有显著的现代疾病分类与临床生化、物理及病理诊断特点,而中医临床讲究四诊合参与辨证论治,强调整体观,缺少具有标识性的疗效指标及相应标准,这些差异是医保支付方式改革需要考虑的。因此,本文提出以参保人健康为导向,遵循中医药自身发展的规律和特点,探索建立按价值付费的医保支付体系,充分发挥中医药“简、便、验、廉”和辨证施治的优势,为医保支付方式改革更好地促进中医药发展提供思考。

Traditional Chinese medicine has its unique advantages over Western medicine in the treatment of chronic diseases, disease prevention and rehabilitation. Reasonable medical insurance payment system plays an important role in promoting the development of traditional Chinese medicine. The current medical insurance payment methods such as fee-for-service, DRG/DIP payment have significant characteristics of modern disease classification, with clinical biochemical, physical and pathological diagnosis. Traditional Chinese medicine pays attention to comprehensive analysis by the four examination methods as well as syndrome differentiation and treatment, emphasizes the holistic view, lacking efficacy indicators and standards. These differences need to be considered in the reform of medical insurance payment methods. The paper proposes to establish a value-based medical insurance payment system for the health of the insured, follow the laws and characteristics of the development of traditional Chinese medicine, explore to establish a medical insurance payment system based on value, give full play to the advantages of traditional Chinese medicine in "simplicity, convenience, testing, and cost-effectiveness", as well as syndrome differentiation and treatment, and provide some reference on promoting the development of traditional Chinese medicine in terms of medical insurance payment methods.