目的: 通过对广东省中山市某中医院按病种分值付费（Diagnosis-Intervention Packet, DIP）中医特色病种的实施效果进行统计分析,为进一步推进中医特色病种DIP支付方式改革提供参考。方法: 选择中医特色病种,参照原有综合疗法,重新赋予中医特色病种分值。通过对该医院2021年3月1日至2022年12月31日中医特色病种开展例数、结算金额、病种分类、优势病种、医保结算金额、患者自付费用、医院医保盈余金额等指标进行统计分析,并对中医特色疗法与其他疗法的各项费用进行比较评估,分析DIP支付方式对医疗机构开展中医特色病种的激励作用,从卫生经济学角度分析医保基金结余情况。结果: 对于中医特色病种采取DIP支付方式是可行的,对医疗机构和医务人员的激励效果非常显著,对减少医保基金支出和控制过度诊疗作用显著。2022年度开展的中医特色病种例数和结算金额与2021年同期相比,分别增长3.50倍和3.36倍。从卫生经济学效果来看,采用中医特色疗法为主的病例总费用、医保支付费用、患者个人支付费用均显著减少,医院费用结构进一步优化,医保基金使用更加优化。结论: 开展中医特色病种的DIP支付可以有效提升医疗机构的中医治疗率,提升中医专业医务人员的价值,调动其工作积极性,有效发挥中医“简、便、验、廉”的优势;显著降低药品和耗材费用,减少不必要的治疗;显著提高医保基金的使用效率,符合医疗机构、医保基金、患者、医务人员等多方利益。

Objective: The paper conducts a statistical analysis of the implementation effect of the Diagnosis Intervention Packet (DIP) payment method for traditional Chinese medicine (TCM) characteristic diseases in a hospital in Zhongshan City of Guangdong Province, in order to provide a reference for further promoting the reform of DIP payment method for TCM characteristic diseases. Methods: We selects the TCM characteristic diseases, and reassigns the scores referring to the original comprehensive therapy. By conducting statistical analysis on the number of cases, settlement amount, disease classification, dominant diseases, medical insurance settlement amount, patients' self payment, hospitals' medical insurance surplus amount and other indicators of TCM characteristic diseases carried out by the hospital from March 1, 2021 to December 31, 2022, we compares the costs of TCM characteristic therapies with other therapies, analyzes the incentives of DIP payment method on medical institutions carrying out TCM characteristic diseases, and analyzes the balance of medical insurance funds from the perspective of health economics. Results: It is feasible to adopt DIP payment method for TCM characteristic diseases, which has a significant incentive effect on medical institutions and staff, and can reduce expenditure of medical insurance fund and control excessive diagnosis and treatment. Compared with the same period in 2021, the number of cases and settlement amounts of TCM characteristic diseases carried out in 2022 increased by 3.50 times and 3.36 times, respectively. From the perspective of health economics, the total cost of cases, medical insurance payment, and patients' self payment of TCM characteristic therapies have significantly decreased. The hospital cost structure and the use of medical insurance funds have been optimized. Conclusion: Carrying out DIP payments for TCM characteristic diseases can effectively improve the TCM treatment rate in medical institutions, enhance the value of TCM professional medical personnel, motivates them to participate in the reform, and effectively develop the advantages of TCM, which is simple, convenient, effective and cheap. Also it can significantly reduce the cost of drugs and consumables, reduce unnecessary treatment, and improve the effectiveness of medical insurance funds, taking into account interests of medical institutions, medical insurance funds, patients, medical personnel, and other parties.