The Study On Payment Method Of Inpatient Medical Insurance For Dominant Diseases Of Traditional Chinese Medicine

ObjectiveBy collecting and sorting out the first page data of medical records of TCM medical institutions in C city,this study screened the dominant diseases of TCM in C city,constructed the TCM DRG and TCM DIP grouping schemes of the dominant diseases of TCM,and explored the adaptability of the two disease grouping tools to the appropriate TCM diagnosis and treatment technology.Then,from the perspective of value medicine,this paper puts forward the realization path and reform suggestions of TCM medical insurance payment mode,in order to encourage medical service providers to choose TCM services actively,explore the reform path of TCM medical insurance payment mode,and make TCM characteristic services return to TCM medical value and TCM return to the correct way of serving the people.MethodsTo comprehensively and systematically collect and analyze domestic and foreign literature,policies and practice cases related to the research topic of "TCM medical insurance payment mode".SPSS 25.0 was used to select the top 10 dominant diseases of traditional Chinese medicine in C city from 2019 to 2021 by frequency analysis,combined with the definition method of dominant diseases of managerial TCM.Stroke(remission period)and distal radius fracture were selected as research objects based on the type classification of dominant diseases of traditional Chinese medicine and the selection principle of internal and surgical diseases of traditional Chinese medicine.Multiple linear regression model and CHAID decision tree model were used to study the DRG grouping of the two diseases,and the DIP grouping of the two diseases was matched and exhaustive based on the grouping method of "disease diagnosis + treatment".The expert consultation method was used to optimize the grouping results,and the coefficient of variation and Kruskal-Wallis H test were used to verify the grouping efficacy of TCM DRG and TCM DIP,and the intra-group homogeneity of each group and the rationality of the grouping scheme were evaluated.Finally,comparative research method is used to analyze and compare the advantages and disadvantages of DRG and DIP and their applicability to traditional Chinese medicine.ResultsFrom 2019 to 2021,29,487 inpatients with apoplexy and 1163 patients with distal radius fracture were included in TCM medical institutions.In terms of age distribution,stroke was more common in the elderly,and the age distribution of patients with distal radius fracture was dispersed,with females accounting for 60.28%.In terms of hospitalization of patients with the two diseases,83.29% of stroke patients had no record of any operation or operation on the first page of TCM medical records,and 78.68% of patients with distal radius fracture needed operation,showing obvious characteristics of surgical treatment.In the process of hospitalized diagnosis and treatment of the two diseases,the proportion of the patients who chose to use traditional Chinese medicine and Western medicine,the use of traditional Chinese medicine diagnosis and treatment equipment,traditional Chinese medicine diagnosis and treatment technology and syndrome differentiation care was more than 95%,showing strong characteristics of traditional Chinese medicine diagnosis and treatment.From the perspective of hospitalization costs of the two diseases,the cost composition of distal radius fracture shows obvious characteristics of surgical diagnosis and treatment,and the cost composition analysis of stroke(convalescent period)mainly based on medical treatment shows the value of TCM technical labor.In this study,9 stroke and 7 distal radius fracture DRGS were constructed with an average coefficient of variation of 0.54 and 0.56 respectively.Kruskal-Wallis H test values of the two disease models were P<0.001.The intra-group homogeneity and inter-group differences of the case combination model of the two diseases were statistically significant,indicating that the grouping of DRG cases was reasonable and the DRG model had certain feasibility.At the same time,we constructed 21 DIP core diseases of stroke with an average coefficient of variation of 0.45,8 DIP core diseases of distal radius fracture with an average coefficient of variation of 0.38,and Kruskal-Wallis H test value P<0.001,indicating that the DIP core disease group of the two diseases had good intra-group homogeneity.There were some differences in hospitalization cost and resource consumption among the groups,and the grouping was reasonable and effective.ConclusionIt is found that DRG grouping based on western medical theories and medical systems is temporarily difficult to adapt to TCM diagnosis and treatment characteristics,and the existing DRG grouping,payment and evaluation system is difficult to incorporate TCM information such as TCM syndrome and TCM traditional characteristic operation,which cannot reasonably reflect the application value of TCM in diagnosis and treatment.It is also necessary to deepen the development of TCM according to the law of TCM development,strengthen the reform and management of TCM clinical pathways,strengthen the statistics of TCM medical records,and lay a solid foundation for the reform of TCM medical insurance payment.DIP grouping is inclusive to TCM diagnosis and treatment.The DIP grouping combines disease diagnosis with TCM intervention methods.The data information requirements and grouping process are simple,easy to popularize,and easier to introduce the value medical concept,which is conducive to promoting the value medical treatment of TCM.It is suggested to speed up the establishment of quantifiable comparison of TCM and western medicine therapeutic value evaluation standards and build a TCM clinical comprehensive value evaluation system.