| BackgroundTraditional Chinese medicine is the practice of people of all ethnic groups living in thousands of years in China and formed in fighting against diseases. It continues to enrich to develop medical science and is the treasure of traditional culture and an important part of the State health services. Traditional Chinese medicine features "simple, convenient, cheap, check" in providing medical services for residents. It has the obvious economic advantages and significant effect of services for solving the current "high cost of getting a treatment and difficulty in seeing a doctor" issue. In the current implementation of related policies, some traditional Chinese medicine policies cannot be carried out very well, to a certain extent hinder its development. In many policies of promoting the development of traditional Chinese medicine, how to better play the role of health insurance policy is crucial. However, in practice there are still many problems to be studied:one is how to better take into account the particularity of Chinese medicine services in project management; the other is the defect of medical standard in Chinese medicine services; the third is limitations in features of traditional Chinese medicine reimbursement. Currently, parts of China have completed urban and rural resident medical insurance of integration work. Strengthened policy research to encourage providing and using Traditional Chinese medicine services in urban-rural residents medical insurance can better to play the features of urban-rural residents medical insurance, to expand its influence, to improve its capacity of fund guaranteeing, to promote the solution of " high cost of getting a treatment and difficulty in seeing a doctor " problem; While, It can promote the solution the exists problem of traditional Chinese medicine development and the achievement of development target of "equal emphasis on Chinese and Western Medicine ".ObjectivesOn the basis of political analysis, literature review and investigation, we further found the issues on provision and use of traditional Chinese medicine, its compensation in urban-rural residents medical insurance and analyzed its affecting factors and proposed appropriate policy recommendations.MethodsOn the basis of the research of traditional Chinese medicine support policies in some provinces and cities, representative sampling method was used to select Weihai, Dongying and Zibo completing integration of medical insurance for urban and rural residents as sample areas in Shandong province. Layered random sampling method was used to select a district and a County in sample areas, surveying public traditional Chinese medicine hospitals and integrated hospitals, each sample district (County) randomly extracted 3 streets(Townships), each street (Township) randomly extracted 2 neighborhoods (villages), each neighborhood (village) selected 20 households family. Investigation included provision and use of traditional Chinese medicine services and its compensation in health insurance for urban and rural residents, and so on. Comparative analysis method was mainly used to providing and use of traditional Chinese medicine services before and after the integration of urban-rural residents insurance in County Hospital.Results1.Summary on the development of Chinese medicine-related policy, we found that political support measures for Chinese medicine services included implementing preferential policies for reimbursement of services and payment reform.2.Integration of medical insurance for urban and rural residents of sample areas was good. Insurance rates were above 98%.3.Comparison of service delivery of before and after the integration of urban-rural residents insurance, we found that Chinese medicine services in the out-patient services and hospital services had a growing trend, outpatient services grew by 0.80%～36.75%, hospital services grew by 9.24%～41.15%. However, the people in outpatient services had a lower proportion. The minimum hospital was only 2.29%.4.Through the analysis of compensation for traditional Chinese medicine, reimbursement for medicine was higher than 60% and reimbursement for project was low.Discussions and Policy SuggestionsFrom service availability and use of traditional Chinese medicine before and after the integration of health insurance for urban and rural residents, a gradual weakening was in primary service, especially out-patient services, lacking of policy support. The affecting factors mainly included three aspects:first, political effect, traditional Chinese medicine had its itself of law, but medical insurance fund management taken into particularity with difficulty. Second, measure standard effect, medical standard measure between health insurance policy and traditional Chinese medicine had relative defect. Third, medical target effect, reimbursement policy for traditional Chinese medicine projects existed limitations. On this basis of these above, this research can be used to encourage policies, mandatory policies and priority strategies to strengthen policy support for traditional Chinese medicine services and propose the future directions.1.Improving the proportion of the projects of service.2.Imposing preferential policies on dominant diseases of traditional Chinese medicine reimbursement.3. Promo ting mixed payment methods reform... |
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