State Medical Insurance Bureau: increase support for designated TCM medical institutions and TCM medical service projects

According to the State Medical Insurance Bureau, on May 19, Yu Yanhong, secretary of the Party Leadership Group of the State Administration of Traditional Chinese Medicine, and Li Tao, member of the Party Leadership Group and deputy director of the State Medical Insurance Bureau, led a team to the Guang'anmen Hospital of the Chinese Academy of Traditional Chinese Medicine to carry out a special research on "medical insurance supports the development of traditional Chinese medicine".
In February this year, the General Office of the State Council issued Several Policies and Measures on Accelerating the Development of Traditional Chinese Medicine, proposing to explore medical insurance payment methods that conform to the characteristics of traditional Chinese medicine, release advantageous diseases of traditional Chinese medicine, and encourage the implementation of the same effect and same price of traditional Chinese and western medicine. It can be seen that the survey conducted by the National Health Insurance Bureau is also the implementation and promotion of national policies.
Increase support for designated TCM medical institutions and TCM medical service projects
It is reported that the relevant responsible persons of Guang'anmen Hospital reported and exchanged information on medical insurance support for the development of hospital preparations, pricing of traditional Chinese medicine non drug therapy, approval of new projects and new technologies, addition of traditional Chinese medicine decoction pieces, and payment for Internet diagnosis and treatment.
Academician Huang Luqi, President of the Chinese Academy of Traditional Chinese Medicine, pointed out that it is necessary to strengthen the evidence-based medicine research and health economics research of TCM dominant diseases based on medical insurance payment, establish research institutions and standard databases of TCM medical security, improve the quality and level of efficacy evaluation, and provide a basis for establishing a medical insurance payment policy that conforms to the characteristics of Chinese medicine.
Li Tao, deputy director of the National Health Insurance Bureau, pointed out that the National Security Bureau attaches great importance to the work of traditional Chinese medicine and strongly supports the development of traditional Chinese medicine; We will continue to improve the Chinese medicine policy guarantee mechanism, and increase support for designated Chinese medicine medical institutions and Chinese medicine medical service projects; Together with TCM management departments and experts, we will formulate industry standards and specifications that conform to the characteristics of TCM diagnosis and treatment and drug use, and form medical insurance payment methods and project pricing policies that are conducive to the development of TCM.
Yu Yanhong, secretary of the Party Leadership Group of the State Administration of Traditional Chinese Medicine, pointed out that we should strengthen communication and cooperation, promote the reform of "three medical linkage", establish a project pricing model based on the efficacy of traditional Chinese medicine and health economics data, and explore the reform of the payment method of traditional Chinese medicine medical insurance; Properly resolve the contradiction between the advance payment of total medical insurance and the rapid growth of TCM services, promote the development of designated TCM hospitals and grass-roots TCM hospitals, and maximize the role of TCM.
Relevant medical insurance policies have been issued in many places to support the development of traditional Chinese medicine
At present, relevant medical insurance policies have been issued to support the development of traditional Chinese medicine. Just a few days ago (May 17), Tai'an City, Shandong Province introduced ten measures for medical security to support the development of traditional Chinese medicine, which will be implemented from May 1, 2021.
First, bring qualified TCM institutions into the designated scope of medical insurance in a timely manner, and bring designated hospitals of TCM at all levels into the designated medical institutions of nationwide remote inpatient online settlement and provincial remote outpatient chronic disease online settlement.
Second, the total budget of medical insurance is inclined to TCM medical institutions.
Third, timely include qualified Chinese patent medicines, Chinese herbal decoction pieces and Chinese herbal formula granules into the medical insurance payment.
The fourth is to reduce the reimbursement standard for hospitalization of TCM institutions and the proportion of first payment for TCM individuals.
Fifth, we will increase the proportion of hospital expenses reimbursed for TCM services.
Sixthly, we will promote the collection and payment of advantageous diseases of traditional Chinese medicine by disease type, and bring 8 advantageous diseases of traditional Chinese medicine, such as supracondylar fracture of humerus, into the management scope of collection and payment of fees by disease type.
Seventh, therapeutic acupuncture, massage, TCM bone injury, TCM anus and intestines and other TCM characteristic advantage projects, as well as TCM constitution identification, pulse diagram diagnosis and other appropriate new technologies will be included in the payment scope of the medical insurance fund.
Eighth, carry out the pilot project of medical insurance settlement management in the day ward of traditional Chinese medicine, and include 24 diseases of traditional Chinese medicine suitable for treatment in the day ward into the medical insurance payment, so as to improve the service level and efficiency of traditional Chinese medicine.
Ninth, promote the price reform of TCM medical services, straighten out the price comparison relationship, and optimize the price structure.
Ten is to support the healthy development of "Internet+TCM".
In September 2020, Shandong Province issued Several Measures on Strengthening Medical Security to Support the Development of Traditional Chinese Medicine (hereinafter referred to as "Several Measures"). We will strengthen the support of medical insurance policies for traditional Chinese medicine through 20 specific measures in 7 aspects, including supporting the development of traditional Chinese medicine institutions, supporting the innovation of traditional Chinese medicine service model, and supporting the integration of production, supply and marketing of traditional Chinese medicine materials.
In addition, according to the recent news from the Guangdong Provincial Medical Insurance Bureau, Shenzhen Medical Insurance deeply implemented the national and provincial decisions and arrangements, and actively explored the medical insurance payment methods that conform to the characteristics of traditional Chinese medicine. Since the official implementation of the directory of advantageous diseases of traditional Chinese medicine in January 2020, it has played a positive role in guiding medical institutions in Shenzhen.
Shenzhen innovatively uses diagnostic codes of traditional Chinese medicine to promote the construction of clinical standardization and standardization of traditional Chinese medicine. Shenzhen medical insurance combines the reform of multiple composite medical insurance payment based on payment by disease type and disease group, and gradually optimizes the single disease medical insurance settlement mode of traditional Chinese medicine hospitals. In the newly revised payment method, it is clear that the dominant diseases of traditional Chinese medicine will be included in the management of the disease score catalogue, and the payment will be implemented according to the disease score.
At the same time, Shenzhen has established a dynamic adjustment mechanism for the catalogue of TCM advantageous diseases, and continued to expand the scope of settlement. In 2020, the list of advantageous diseases of traditional Chinese medicine in Shenzhen included 28 diseases, covering 99 TCD codes, including advantageous specialties of traditional Chinese medicine such as anorectal, bone injury, digestion, endocrinology and facial paralysis. Throughout the year, 8192 patients with advantageous diseases of traditional Chinese medicine were treated in 15 traditional Chinese medicine hospitals, achieving a comprehensive balance.
On the basis of expanding data collection and improving data quality, according to the established selection path, the list of TCM dominant diseases in 2021 will be expanded to 51 diseases from the original 28 TCM diseases (82.1% higher than that in 2020), covering 149 TCD codes (50.5% higher than that in 2020). The plan to select 50 TCM diseases in three years has been completed ahead of schedule, and the coverage of TCM dominant diseases continues to be expanded.