目的: 为解决中医在按病组（DRG）付费/按病种分值（DIP）付费医保支付体系下面临的支付标准偏低、价值难以体现的问题,本研究以中西医“同病同效”为前提,探索中西医治疗“同支付”的实现路径,并以桡骨骨折为例提出按病种付费支付标准。方法: 基于广东省佛山市医院临床实践,构建涵盖安全性与有效性的同病同效评估体系,结合DRG支付大数据与临床专家意见,验证桡骨骨折中医疗效与西医疗效一致性,并在此基础上测算合理费用水平,制定按病种付费支付标准。结果: 评估表明,桡骨骨折中西医疗效一致,据此制定的支付标准高于中医平均费用,低于西医平均费用,既保障了医院的积极性,又保持了中医的价格优势。结论: 本研究从“同病同效”出发,探索了中西医“同支付”的实现路径,结果显示,该方案兼顾患者负担、医疗机构收益与医保基金支出,对医保支付方式改革和中西医协同发展具有参考价值。

Objective: In the DRG/DIP medical insurance payment system, traditional Chinese medicine (TCM) often faces relatively low payment standards and difficulties in reflecting its value. This study explores a way to realize “same payment” based on “same disease and same efficacy” between TCM and western medicine, using radial fracture treatment as an example to develop a case-based payment standard. Methods: Based on clinical practice in hospitals of Foshan City, Guangdong Province, an evaluation framework covering both safety and effectiveness was established. By integrating DRG payment big data with expert opinions, the equivalence of treatment outcomes between TCM and western medicine for radial fractures was verified. Based on these results, reasonable cost levels were estimated and a corresponding payment standard was formulated. Results: The evaluation showed comparable efficacy between TCM and western medicine in radial fracture treatment. The proposed price based on the study is higher than the average TCM cost but lower than the western medicine cost, ensuring hospital motivation while maintaining the price advantage of TCM. Conclusion: Based on the principle of “same disease and same efficacy”, this study explores implementation pathways of “same payment” for TCM and western medicine. The findings indicate that the proposed scheme balances patient affordability, hospital revenue, and medical insurance expenditure, which offers important reference for medical insurance payment reform and the coordinated development of TCM and western medicine.