目的: 比较分析各省市开展中医优势病种遴选实施情况,为国家及未开展地区实施中医医保支付改革提供参考。方法: 通过政策梳理及文献研究,分析8个省份和24个地市实施中医按病种付费的病种遴选情况。结果: 各省市在中医优势病种数量、付费范围和方式、病种实际遴选、付费标准上均存在一定差异。结论: 各省市中医优势病种实施程度的差异性体现在对政策的关注和认识程度不同、各地按病种付费的成熟度不同;各省市遴选病种的原则和侧重科室相同,但遴选的具体病种不同,开展付费病种编码使用也不规范。各省市中医优势病种付费标准可按中医诊疗服务特点进一步优化。

Objective: The paper compares and analyzes the implementation and selection of Traditional Chinese Medicine (TCM) dominant diseases in various provinces and cities, so as to provide a reference for the implementation of TCM medical insurance payment reform in China. Methods: By means of policy review and literature research, the selection of TCM dominant diseases implemented in 8 provinces and 24 cities was analyzed. Results: There were differences in the number, the scope and mode of payment, the actual selection of diseases, and the payment standard of TCM dominant diseases among the provinces and cities studied. Conclusion: The differences in the implementation of TCM dominant diseases in various provinces and cities lie in the different degree of attention, understanding and maturity of the policy. The principles and departments for selecting diseases in various provinces and cities are same, but the specific diseases selected are different, and the coding of diseases is not standardized. The payment standards for TCM dominant diseases in various provinces and cities can be further optimized based on the characteristics of TCM diagnosis and treatment services.