Implementing payment based on diseases types for traditional Chinese medicine (TCM) advantageous diseases is an effective way to explore the payment mode of medical insurance in line with the characteristics of TCM, which is of great significance to promote the inheritance and innovation of TCM. The rise of big data and artificial intelligence technology has brought new opportunities for the development of innovative TCM. In view of the limitations existing in the current implementation of payment by disease types of TCM advantageous diseases, which leads to the problem that the advantages and value of TCM treatment are not fully reflected, this paper proposes to integrate digital intelligence technology to build a basic data management system, therefore achieving the expression of data as structured information, improving the quality of TCM diagnosis and treatment data through data homogenization research, and using modern digital intelligence technology to mine, analyze and transform TCM human experience, so as to explore a new strategy to support payment by disease types of TCM advantageous diseases. Through a series of measures, we hope to provide reference for the development of medical insurance payment for TCM advantageousdiseases, and promote the sustainable and high-quality development of TCM.
Key words
TCM advantageous diseases /
big data technology /
artificial intelligence /
human-based experience /
data management
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 张诗文,王丽丽,荆丽梅,等.中医优势病种支付方式改革的典型经验、共性问题与对策研究[J].中国卫生经济,2024(08):22-27+33.
[2] 中共中央,国务院.关于促进中医药传承创新发展的意见[EB/OL].(2019-10-20)[2025-07-23].https://www.gov.cn/xinwen/2019-10/26/content_5445336.htm.
[3] 国务院办公厅.关于加快中医药特色发展若干政策措施的通知[EB/OL].(2021-01-22)[2025-07-23].http://www.gov.cn/zhengce/content/2021-02/09/content_5586278.htm.
[4] 国家中医药管理局,国家数据局.关于促进数字中医药发展的若干意见[EB/OL].(2024-07-19)[2025-07-23].https://www.gov.cn/zhengce/zhengceku/202408/content_6968519.htm.
[5] 于伟,李佳宁,钟璐,等.中医优势病种按疗效价值付费改革效果分析[J].卫生经济研究,2025,42(04):23-27.
[6] 苏芳,肖彩波.中医按疗效价值付费政策实施效果及优化策略研究——基于典型地区的比较[J].湖南中医杂志,2025,41(01):188-192.
[7] 廖藏宜,秦纪华,蓝志成.中医优势病种按疗效价值付费的柳州经验[J].卫生经济研究,2023,40(06):61-63+67.
[8] 王明飞,肖晓兰,粟保元.DRGs付费模式下中医病案首页质控研究[J].医学信息,2024, 37(15):173-176.
[9] 李新龙,黄培冬,朱爽,等.智能化挖掘中医临床诊疗数据面临的问题和挑战[J].中华中医药杂志,2022,37(12):6962-6965.
[10] 刘保延,张红,倪皖东.试论中医电子病历系统及其特殊性[J].医学信息,2004(01):9-11.
[11] 高阳,祖亮华,刘冉,等.中医纳入疾病诊断相关分组的思考[J].卫生经济研究,2023,40(11):5-8.
[12] 黎倩欣. 中医优势病种住院医保支付方式研究[D].广州:广州中医药大学,2023.
[13] 杨忠奇,唐雅琴,汤慧敏,等.构建基于最佳临床经验的临床疗效评价体系[J].中国中药杂志,2023,48(18):4829-4833.
[14] 李晶娅. 中风病指南与共识的评价及“近现代医家经验”证据评价方案的研究[D].北京:北京中医药大学,2022.
[15] 杨菁,李梦滢,沈际勇.中医优势病种支付方式改革试点经验与启示[J].卫生经济研究,2023,40(12):33-38.
[16] 张敬华,杨若宁,叶丹,等.医保DRG/DIP支付改革下中医优势病种应用现状[J].卫生软科学,2024,38(08):4-6.
[17] 刘艳飞,孙明月,姚贺之,等.大数据技术在中医药领域中的应用现状及思考[J].中国循证医学杂志,2018,18(11):1180-1185.
[18] 朱瑶. 中医儿科专病病例报告表规范化及临床示范研究[D].武汉:湖北中医药大学,2023.
[19] 国家中医药管理局医政司.中医病案书写规范[M].北京:国家中医药管理局医政司,1991.
[20] 刘保延,中医药大数据与疗效评价技术研究[Z].北京:中国中医科学院,2021-03-29.
[21] 刘静,中医药学语言系统和中医临床术语系统年度更新[Z].北京:中国中医科学院中医药信息研究所,2019.
[22] 高蕊. 符合中医特色临床评价体系的构建与思考[J].中国新药杂志,2021,30(09):780-783.
[23] 栾奕博,胡思源.人用经验证据支持儿童中药新药注册及说明书变更的若干思考[J].药物评价研究,2022,45(2):205-209.
[24] 展志宏,戴国华,张丛惠,等.人工智能在中医临床疗效评价中的应用现状及未来发展对策[J].中华中医药杂志,2024,39(04):1702-1706.