Quantitative Evaluation and Optimization of Medical Insurance Payment Policies for Traditional Chinese Medicine Rehabilitation Therapy in China

doi:10.19546/j.issn.1674-3830.2025.7.013

China Health Insurance ›› 2025, Vol. 0 ›› Issue (7) : 96-104. DOI: 10.19546/j.issn.1674-3830.2025.7.013

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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.

Key words

traditional Chinese medicine rehabilitation / reform of medical insurance payment methods / PMC index model

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Quantitative Evaluation and Optimization of Medical Insurance Payment Policies for Traditional Chinese Medicine Rehabilitation Therapy in China[J]. China Health Insurance. 2025, 0(7): 96-104 https://doi.org/10.19546/j.issn.1674-3830.2025.7.013

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