| Research background:Beijing in recent years, we found that many items not listed in the government to carry out clinical diagnosis and treatment of traditional Chinese medicine project directory, or has been listed in the directory of the project rate is too low, widespread losses. At present Beijing traditional Chinese medicine health service price cannot fully manifest the value of services of traditional Chinese medicine, part of traditional Chinese medicine diagnosis and treatment projects, due to the price factor is difficult to carry out in clinical application, restricting the development of TCM cause. Make medical institutions of traditional Chinese medicine to finance operations with debt, hard to break even on its own medical business, also serious impact on the characteristics of traditional Chinese medicine hospital of traditional Chinese medicine.Establish and standardize the TCM diagnosis and treatment projects and price system of research, can provide the government pricing departments with basis, so as to further improve the medical services of traditional Chinese medicine scientific project pricing, promote application, protection and characteristics of traditional Chinese medicine therapy of mining, push forward the sustainable development of the capital, the doctor of traditional Chinese medicine, Chinese medicine health care services for residents to provide quality.In2012, the national development and reform commission, the ministry of health and state administration of traditional Chinese medicine in "on normative medical service price management and related issues notice"(hair change price [2012] no.1170, hereinafter referred to as the "national standard") pointed out:"the standard management of medical service prices is the implementation of the deepening medical and health system reform important content, is to promote the reform of medical service prices, specifications, price behavior of medical institutions, maintaining the lawful rights and interests of patients with important measures, to perfect the compensation mechanism of medical institutions, medical expenses burden is of great significance to relieve patients.------around to finish by the end of2013the region has been implementation of the medical service price project cleaning specification’This paper involved the study of establishing service project of Beijing traditional Chinese medicine diagnosis and treatment system with9provinces and cities service project price survey analysis and research of traditional Chinese medicine diagnosis and treatment of this two parts content.Research content:Under the guidance of tutor, we won the bid in2012, the development of Beijing’s capital medical research foundation of the research subject "the standard of Chinese medicine services, explore to establish Beijing service price system of traditional Chinese medicine". This paper reports the establishment of Beijing traditional Chinese medicine diagnosis and treatment services system research and the nine provinces of TCM diagnosis and treatment services price research analysis and study the two parts contentPart one:according to the Beijing traditional Chinese medicine medical situation, discovers the sampling selected9level3(itcwm) of traditional Chinese medicine hospital (the gate of the hospital, xiyuan hospital, Beijing hospital, ophthalmology, Oriental hospital, hospital, the dongzhimen hospital of Beijing university of Chinese medicine in the third affiliated hospital, Beijing hospital of traditional Chinese medicine, xuanwu hospital of traditional Chinese medicine) and10all the representative area county hospital of traditional Chinese medicine combine traditional Chinese and western medicine hospital (Beijing, protecting temple, chaoyang district hospital of traditional Chinese medicine (TCM), fangshan district hospital of traditional Chinese medicine, hospital, huairou district hospital of traditional Chinese medicine, Chinese medicine hospital of traditional Chinese medicine (TCM), shunyi district, changping district hospital, the dongzhimen hospital east, miyun county hospital of traditional Chinese medicine, yanqing county hospital of traditional Chinese medicine), collecting, sorting and demonstrate the current services of traditional Chinese medicine in Beijing, including those that "Beijing unified medical service fee standards"(hereinafter referred to as "red book", published in1999) did not, but the doctor of traditional Chinese medicine hospital has been carried out or not carried out but is able to carry out the doctor of traditional Chinese medicine diagnosis and treatment projects. We have collected823items. After a comprehensive interdisciplinary48Chinese medicine experts and scientific sorting, screening and demonstrate repeatedly, eventually in the Beijing area were determined in514TCM clinical diagnosis and treatment services.We collect demonstration project of Beijing traditional Chinese medicine diagnosis and treatment of:1, project number:514.2, the project classification:is divided into9classes, respectively, of traditional Chinese medicine (TCM) acupuncture and moxibustion (77), fractures (79), Chinese medicine massage therapy treatment (80), anorectal therapy (49) of traditional Chinese medicine, Chinese medicine external treatment (37), TCM psychological therapy (73), Chinese medicine special treatment (32), composite (36) of traditional Chinese medicine, Chinese medicine equipment (51).3, system contents of project:including project name, project code, project classification, the connotation of the project, except the numeraire, invoicing instructions and contentThat result from the number compared with the code for the national337project of traditional Chinese medicine, more than177,167new items, including10new specification for the TCM group project), accounting for52.5%of the "national standard" of traditional Chinese medicine health care services. Compared with the "national standard" from content:(1) to modify the "national standard" the name of the individual project and the connotation of the (2) add new projects, added content is slightly different (4)(3) project classification specific projects in the same project classification has a slight adjustment.Part2of9provinces and cities (Shanghai, chongqing, zhejiang, hubei, guangdong, heilongjiang, jilin, sichuan, gansu), group from the Beijing united medical service fee standards (1999)"(hereinafter referred to as the red book) in the selected54clinical commonly used, reflects the characteristics of traditional Chinese medicine service projects and service projects in nine provinces of the same TCM diagnosis and treatment of price comparison analysis:Beijing Chinese medicine medical services fees for each price of8.85yuan on average, nine provinces is22.02yuan, the price level is much lower than other provinces, such as acupuncture, Beijing every acupuncture point charge only0.4yuan, the other nine provinces and the average of2.4yuan; Pick treatment, fee standards for3yuan each time, in Beijing and other provinces and the average rate of24.5yuan, the price of the guangdong reach18times in Beijing, reached55yuan per person. And Beijing’s per capita GDP level in10provinces and cities in2011, the second is81658yuan, second only to Shanghai (level of GDP per capita82560yuan); Beijing’s per capita health care spending in the first place, as per capita1523.32yuan,36.4%higher than the average of10provinces and cities. But the Beijing Chinese medicine service charge price is in the lowest level.research results:1.the TCM project quantity is too little, can’t meet the needs of Chinese medicine clinical and patient.In2012issued by the national development and reform commission (NDRC) of the national health service price project specification (2012edition)", a total of9360projects, including project337items of traditional Chinese medicine, only accounted for3.6%of all projects. The current "standard of Beijing united medical service charge"(hereinafter referred to as the "red book", published in1999) in the TCM project88items, only can’t meet the needs of clinical patients and doctors of traditional Chinese medicine. Though the national standard "than" Beijing red book "of traditional Chinese medicine project has increased dramatically, but with our topic of price system "of traditional Chinese medicine (TCM) clinical research of Beijing medical services for514the results still has bigger gap,177traditional Chinese medicine health service project is still not listed in the state and municipal medical service price paid directories.This will cause many people health needs are not being targeted therapy of traditional Chinese medicine, and make some inherited from unique in the history of Chinese medicine therapy can’t carry out, eventually lead to lost, unable to make up for the loss. 2.now the standard of the TCM project technical difficulty is set too low, is not conducive to the next step for the priceFrom the project with the western medicine diagnosis and treatment of traditional Chinese medicine diagnosis and treatment of Beijing project technical difficulty, the proportion of36%of the project of traditional Chinese medicine, western medicine has25%of the difficulty coefficient between0-39of the project, the difficulty coefficient is lower11%than western medicine of traditional Chinese medicine; The doctor of traditional Chinese medicine, western medicine has a49%36%of project project of difficulty coefficient between60-99, difficulty coefficient of higher project was13%less than western medicine of traditional Chinese medicine. Visible, compared with western medicine, Beijing traditional Chinese medicine diagnosis and treatment projects still low the difficulty coefficient, limit the next set of traditional Chinese medicine service price.3. Chinese medicine project to make sure that the risk degree is lowFrom Beijing Chinese medicine project and the project risk factor scale map, the doctor of traditional Chinese medicine has a66%project risk coefficient between0-39, western medicine has63%of the project risk coefficient between40-79. visible, and most of the project risk coefficient is much higher than western medicine TCM project4. The current Chinese medical service price is lowBeijing and nine provinces mainly compared the price of medical service of traditional Chinese medicine, Beijing traditional Chinese medicine medical services fees for each price of8.85yuan on average, nine provinces is22.02yuan, the price level is much lower than other provincesAcupuncture, for example,"Beijing medical service prices" in regulation: acupuncture (including acupuncture, acupuncture and auricular needle rapidly, plum needle, electric acupuncture, needle, needle, wrist, ankle, tube with acupuncture and moxibustion, etc.) each time is4yuan, acupuncture plus moxibustion6yuan each time. Once a patient acupuncture is in commonly10points, Some even over20points, the charge standard costs lead to acupuncture can’t recover Price based on the value of goods and services, according to the supply and demand is fluctuating around the value. Now Beijing TCM medical service prices seriously deviate from the value of the project, generally below cost, lead to long-term loss of traditional Chinese medicine hospital management, both cause of traditional Chinese medicine hospital management is struggling the reality of the difficulties, and the long-term development of the cause of Chinese medicine in Beijing brought serious impact and hazard.Doctor of traditional Chinese medicine health care services charge standard is too low, the doctor of traditional Chinese medicine hospital only rely on the service fee is hard to compensate the loss. Result is hospital of traditional Chinese medicine had to give up a lot of unique curative effect of traditional Chinese medicine treatment, in order to survive and leave in from the west, make the patient cannot meet the demand for these treatments, also makes some valuable traditional therapy without causing lost for a long time.5. The Beijing Chinese medicine services and the city’s GDP and per capita spending on health care does not adaptIn2011the city’s per capita GDP level in10provinces and cities in the second, second only to Shanghai (see figure4); Per capita spending on health care in the first place, as per capita1523.32yuan,36.4%higher than average of10provinces and cities, but only the Beijing Chinese medicine service price lowest in10provinces and cities.policy Suggestions:(1) the Beijing traditional Chinese medicine health service price adjustment is imperative.The study of medical service projects, Beijing hospital of traditional Chinese medicine of doctor of traditional Chinese medicine medical services, the average price is8.85yuan, in the research of ten provinces and cities, not only at the lowest level, and the price gap with other provinces is very great. Price as a service control economic leverage, Beijing TCM medical service prices are far away with its economic development level and the position in the national health system does not adapt, does not reflect the doctor of traditional Chinese medicine health service in the medical costs and the value of the service of the doctor. Beijing traditional Chinese medicine medical services price adjustment is imperative..(2) the standard of Chinese medicine servicesEstablish the service system of traditional Chinese medicine in Beijing, will be suitable for Chinese medicine clinical need, reflects the characteristics of traditional Chinese medicine diagnosis and treatment projects into the system. Such as TCM psychological treatment and equipment of traditional Chinese medicine. Make it basically covers the existing services of traditional Chinese medicine, in order to establish conforms to the law of development of traditional Chinese medicine, play special advantage, scientific system of capital of Chinese medical service price system to provide the basis of the factual and objective data and detailed basis.Chinese medicine known as "Jane, and cheap, check" word of mouth, can provide accessible and feasible for the people and economy of medical services. If reasonable services of traditional Chinese medicine "cheap", to control rising health care costs; On the contrary, if the "cheap", will affect the enthusiasm and creativity of medical services by the supplier, is bound to hinder the clinical use of TCM medical services. At present Beijing traditional Chinese medicine health service project price cannot reflect its value, influence the development of the cause of Chinese medicine, TCM medical service project price reasonable adjustment is imperative.(3) establish a scientific and reasonable price system of Beijing Chinese medicine services1.the principle of price adjustmentPrice adjustment should follow the "total amount control. structural adjustment, cut peak valley, drop low high fill" principle.Keep health overall price stability, do not increase the burden of the masses of the people, not beyond society’s ability to pay.2. main measures of price adjustmentreduce the large-scale high-end medical equipment and parts inspection charge standard of the project.The large inspection equipment charging standard is higher, to a certain extent caused the excessive medical behavior, medical services expenditure of rising at the same time. Will not reasonable inspection project large-scale high-end medical equipment, part of the charge standard is reduced, can save the cost for serious deviate from the value of traditional Chinese medicine medical services price adjustment, realize the total spending on medical services under the control of structural adjustment(2) the doctor of traditional Chinese medicine health care services in full cost accounting.Will be in Beijing to full cost accounting of all514projects, find out the cost of all project content, provide TCM medical service price adjusting policy and based on facts.(3) make reasonable medical service price of traditional Chinese medicineIn cost accounting, on the basis of item by item, formulate reasonable TCM medical service price, reduce the loss of the doctor of traditional Chinese medicine health care services. Medical service price is control of economic leverage, and is also the important economic source of maintain the normal operation of hospital.Beijing Chinese medicine medical services income accounts for only about10%of the city’s medical income, part of the project after adjusting for global influence is not big. Disease to the superiority of TCM, such as manual reduction, small needle knife and so on, not only with the surgical efficacy of western medicine, and the patient less painful, should be carried out and the diseases and price policy, not only can contribute to the popularization and application of traditional Chinese medicine service, but also on the whole a strategy to reduce medical costs. Cheap curative effect good project of traditional Chinese medicine such as pricing, project is no longer in the traditional Chinese medicine hospital, the patient would have to adopt high price of western medicine treatment project, so that residents will increase and the cost burden of health care. TCM medical service pricing projects, therefore, lead to the development of TCM project, not only increase the medical care expenditure, it will give full play to the advantages of traditional Chinese medicine in the treatment of some diseases, reduce the patients with large dependence on examination equipment and operation, by changing the medical behavior to reduce health care costs overall spending. It is important to note that in traditional Chinese medicine medical service prices, full attention to labor costs accounted for in the price, namely technical labor value. Emphasis on evidence-based medicine doctor of traditional Chinese medicine, more is the doctor manpower, intelligence of intangible costs, to calculate the cost of doctor of traditional Chinese medicine health care services should fully realize the value of technical services, attaches great importance to human consumption in verification services charge for the important position in traditional Chinese medicine. In Chinese medicine services, most projects use fewer devices, rely mainly on the doctor’s superb technology and rich clinical experience complete medical services, human technology costs accounted for the vast majority of [9] of the whole process cost. The present services of traditional Chinese medicine price ignored the human cost of the medical staff and technical value, most of the project is at a loss. Technical service value ignore directly caused many services of traditional Chinese medicine is used to give up. The traditional bonesetting skill reset, is not only small trauma and quick recovery. But its price is about western medicine surgery tenths of a, so that the medical institutions in order to not to do manual reduction and let the patient go to do surgery, rising health care costs. Acupuncture, for example, have made Beijing hospital cost accounting, in the treatment of a patient need20～30minutes, plus housing, water and electricity, equipment, disinfection needle, dressing, etc. The carrying amount of the consumption and the hospital. Every patient’s direct cost is much higher than the normal acupuncture each time4yuan to collect fees, cost will not be repaid. |
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