目的: 对我国省级中医康复治疗医保支付政策进行量化评价与实证分析,揭示政策实施中的问题和不足,进一步探讨中医康复治疗医保支付政策的优化路径。方法: 借助政策一致性指数模型（policy modeling consistency index, PMC）,对中医康复治疗医保支付政策进行量化评价。结果: 最终纳入15个省份,共39项政策文本。有10个省份被评为“优秀”,5个省份被评为“良好”,均在可接受范围内。总体存在政策性质单一、稳定性欠佳;政策主体权责分工未明确,医保监管有待加强;学科建设与人才体系培养有待完善等问题。结论: 建议强化政策的规范性和稳定性,提高中医药管理部门在政策制定中的参与度,构建全周期、全链条的中医康复治疗医保监管政策,并加强中医康养人才培养与队伍建设。
Abstract
Objective: The paper attempts to uncover issues and deficiencies in policy implementation, explore optimization pathways for medical insurance payment policies related to traditional Chinese medicine (TCM) rehabilitation therapy, and provide references for policy improvement through a quantitative assessment and empirical analysis of medical insurance payment policies for TCM rehabilitation therapy across provinces, municipalities, and autonomous regions in China. Methods: The payment policy of medical insurance for TCM rehabilitation therapy was quatitatively assessed by applying the Policy Modeling Consistency (PMC) index model. Results: A total of 39 policy documents from 15 provincial districts were included in the assessment. 10 provinces were rated as “excellent”, while 5 were deemed “good”, both within acceptable ranges. Overall, the policy nature is similar, with poor stability. The division of responsibilities among policy entities is not clear, and the supervision of medical insurance needs to be strengthened. Disciplinary construction and talent system cultivation is to be improved. Conclusion: It is suggested to strengthen the standardization and stability of policies, increase the participation of TCM management authorities in policy formulation, establish a full cycle and full chain regulatory policy for TCM rehabilitation treatment and medical insurance, and strengthen the training and team building of traditional Chinese medicine rehabilitation talents.
关键词
中医康复 /
医保支付方式改革 /
PMC指数模型
Key words
traditional Chinese medicine rehabilitation /
reform of medical insurance payment methods /
PMC index model
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基金
国家自然科学基金青年项目资助“国家药品集中采购对处方行为的影响机制：识别、测量及改进”（72404281）
