[1]李海龙,马 烨,应晓华.我国中医药医保支付方式改革现状及核心要素比较研究[J].卫生经济研究,2026,43(06):39-44.
　LI Hailong,MA Ye,YING Xiaohua.Comparative Analysis of the Progress and Core Components of Traditional Chinese Medicine Payment Reform in China[J].Journal Press of Health Economics Research,2026,43(06):39-44.
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我国中医药医保支付方式改革现状及核心要素比较研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年06期
页码:
39-44
栏目:
医疗保障
出版日期:
2026-06-03

文章信息/Info

Title:
Comparative Analysis of the Progress and Core Components of Traditional Chinese Medicine Payment Reform in China
作者:
李海龙1; 马 烨1; 应晓华1; 2
1.复旦大学公共卫生学院，上海 200032
2.国家卫生健康委员会卫生技术评估重点实验室（复旦大学）， 上海 200032
Author(s):
LI Hailong;  MA Ye;  YING Xiaohua
School of Public Health, Fudan University, Shanghai 200032, China
关键词:
中医药; 医保支付方式改革; 按病种付费; 中医优势病种
Keywords:
Traditional Chinese Medicine;  medical insurance payment reform;  case-based payment;  dominant diseases in TCM
分类号:
R19；F840.684
文献标志码:
A
摘要:
目的：梳理我国中医药医保支付方式改革现状，总结改革核心要素的共性特征与创新实践，为全国推广提供参考。方法：系统收集2018年至2025年各省及试点地市中医药医保支付方式改革方案，从支付单元、支付价格、覆盖范围、监管保障等方面进行对比分析；采用描述性统计与Jaccard相似系数评估病种类别及省际差异。结果：多数省份（15/18）试点中医住院优势病种按疗效价值付费，少数地区探索单病种定额等复合模式；省级病种前12位高频病种中，骨伤类占比最大（63.5%）；医保价格通常基于资源消耗或疗效价值（中西医“同病同效同价”），多地叠加中医医疗机构或病种层面倾斜激励。结论：中医药医保支付形成以优势病种按疗效价值付费为主的多元模式，但整体病种覆盖有限，省际差异较大，支付标准与激励机制尚不规范，监管体系有待完善。
Abstract:
Objective To analyze the progress of medical insurance payment reform for Traditional Chinese Medicine(TCM), summarize the common characteristics and innovative practices of its core components, and to provide a reference for nationwide policy diffusion. Methods Reform plans for TCM medical insurance payment methods were systematically collected from various provinces and pilot cities. A comparative analysis was conducted across four dimensions of payment units, pricing, coverage, and regulatory mechanisms. Descriptive statistics and Jaccard similarity coefficients were used to assess disease selection and inter-provincial variation. Results Most provinces(15 out of 18) implemented payment according to the value of efficacy for dominant diseases in TCM, while a few adopted mixed models such as single-disease fixed payment. Among the top 12 most common conditions at the provincial level, musculoskeletal injuries accounted for the largest proportion(63.5%). Conclusion TCM medical insurance payment has evolved into a diversified model centered on efficacy-based payment for dominant diseases in TCM. However, there are still issues such as limited disease coverage, significant inter-provincial differences, non-standard payment standards and incentive mechanisms, and the regulatory system that needs to be improved.

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更新日期/Last Update: 2026-06-03