Research On Access Management Of Medical Insurance Catalog For TCM Medical Service Projects

ObjectiveThis study defines the concept and scope of TCM medical service technology projects,collects the management methods for new medical service projects(including TCM),the catalog of diagnosis and treatment projects(in TCM part),and the policies for the reform of medical insurance payment methods for TCM medical service technology projects;analyze the similarities and differences of the medical insurance catalog access management process,medical insurance payment methods and the inclusion of medical insurance for TCM medical service technology projects in various regions,and statistics on medical insurance,not included in medical insurance and Controversial high-frequency TCM medical service technology projects(included in medical insurance in some regions,not included in medical insurance in some regions)are compared with the commonly used TCM medical service technology projects in representative TCM hospitals,and summarize the problems and dilemmas of the access management of the medical insurance catalogue of TCM medical service technology projects,and draw lessons from the access management experience of the medical insurance catalogue of medicines and medical devices in my country.puts forward reasonable countermeasures and suggestions for the inclusion of TCM medical service technology items in the basic medical insurance catalog.Methods1.Using information research and literature research methods,collects the policies related to the inclusion of TCM medical service technology items in medical insurance and the TCM medical service technology items commonly used in representative TCM hospitals,and analyzes the status of access management of TCM medical service technology items in the medical insurance catalog.2.Using the mathematical statistics method,general statistical description and matrix statistics are carried out on the collected policies and traditional Chinese medicine techniques,so as to understand the data distribution,and conduct consistency test for the questionnaire.3.Using PEST-SWOT analysis method,systematically analyze the degree of social and economic benefits generated by TCM medical service technology projects under the guidance of policies,and deeply discuss the advantages and disadvantages of TCM medical service technology projects under the current medical insurance management system,and opportunities and challenges for the further development of TCM medical service technology projects,so as to put forward suggestions and countermeasures to promote the inclusion of traditional Chinese medicine medical service technology into medical insurance.4.Using expert consultation method to conduct expert demonstrations on the concept and scope of TCM medical service technology projects,issue questionnaires anonymously,and investigate relevant TCM workers to recommend the optimal process and elements of new TCM medical service technology project management,and suggestions on the access management of medical insurance catalog for TCM medical service technology projects.Results1.This study named TCM technology as TCM medical service technology projects,the research scope is the National Medical Service Price Item Specification(mainly the 2012 version)and the "Traditional Chinese Medicine and Ethnic Medicine Diagnosis and Treatment" part of the provincial(municipalities,autonomous regions)diagnosis and treatment project catalogue,as well as the commonly used TCM medical service technology items in representative TCM hospitals.2.A total of 27 provinces(municipalities and autonomous regions),including Shanghai,Guangdong,and Chongqing etc,have collect the management measures(including traditional Chinese medicine)of new medical service projects,compare the situation in each region in 9 aspects:the definition of new projects,the applicant unit,the competent department,the acceptance and approval process,the price setting,management during the trial period,project outcome,connection to medical insurance,and supervision and management.The results show that there is no clear management method for the adjustment of medical insurance attributes,and a unified management method for the access to the medical insurance catalogue of TCM medical service technology projects has not been formed,and the number of TCM experts involved in the medical insurance review process is less in quantity.3.At present,a unified medical insurance catalog of TCM medical service technology projects has not been formed,and the website of each regional medical insurance bureau is not publicized in a timely manner.Collected catalogs of diagnosis and treatment projects(TCM part)in 25 regions including Hebei Province and Guangdong Province etc.With reference to the "National Medical Service Price Item Specifications"(2012 edition)to standardize various TCM medical service technical items,a total of 869 TCM medical service technology projects have been included in the medical insurance.Among them,there are 138 high-frequency TCM medical service technology projects,and the most are TCM orthopaedic treatment,52 items;a total of 186 TCM medical service technology projects in various regions that are not covered by medical insurance,19 high-frequency TCM medical service technology projects,and 14 TCM comprehensive projects in total;18 high-frequency controversial TCM medical service technology projects in various regions,there are 11 items in TCM massage therapy category.4.A total of 30 regions including Guangdong Province,Anhui Province and other regions have collected TCM medical service technology project medical insurance payment policies.For the dominant TCM diseases,payment is made by disease type,per head,bed-day,day-time diagnosis and Value-Based Reimbursement(VBR),is still in the exploratory stage.5.From the top 100 public prefecture-level and above tertiary TCM hospitals in 2020 with TCM characteristic advantages and scientific and technological influence,select 2 representative hospitals in each region,and count the TCM medical service technology projects recommended by each TCM hospital,a total of 51 TCM hospitals,28 administrative regions are included.On average,each TCM hospital carries out 40-60 TCM medical service technology projects.It intersects with the high-frequency TCM medical service technology projects included in the medical insurance,obtained 6 items include Chinese medicine retention enema treatment,Chinese medicine iontophoresis treatment,Chinese medicine steam bath treatment,Chinese medicine foot bath treatment,Chinese medicine medicated bath treatment,dog fu stick,etc.,which are widely used in traditional Chinese medicine hospitals,but are not generally included in medical insurance.ConclusionAccording to the management status of the inclusion of TCM medical service technology projects in the medical insurance catalog,the results of PEST-SWOT analysis and the questionnaire survey results,the following suggestions are given for the formulation of the access management policy for the medical insurance catalog of TCM medical service technology projects in this study:1.Vigorously promote TCM medical service technology projects to promote balanced development;2.Standardize the management of medical insurance catalogues for TCM medical service technology projects,including(1)issuing a unified medical insurance catalogue for TCM medical service technology projects as soon as possible;(2)establishing a comparison database of medical insurance catalogues for TCM medical service technology projects and publicizing them in a timely manner;3.As soon as possible,a unified management method for the access management of the medical insurance catalogue of TCM medical service technology projects,including(1)the optimal process and elements of the new TCM medical service technology project management method;(2)the adjustment management of the medical insurance attributes of the TCM medical service technology project Method;4.Continue to explore the payment method of medical insurance for TCM medical service technology projects,focusing on exploring the value-based compensation mechanism(VBR);5.Strengthen related research on TCM medical service technology projects,including(1)speed up the formulation of terminology specifications and operational specifications for TCM medical service technology projects;(2)develop and share TCM medical service technology intelligent physiotherapy instruments and include them in medical insurance;(3)explore Health technology assessment methods suitable for TCM medical service technology projects;6.It is recommended that the items that are frequently used by traditional Chinese medicine hospitals but not generally included in the medical insurance and the high-frequency controversial TCM medical service technology items are included in the medical insurance.