文章摘要
胡小璞,胡晓丽,陈燕,等.基于Delphi法和AHP的浙江省中医非药物疗法医保支付的可行性研究[J].浙江中医药大学学报,2021,(5):475-488.
基于Delphi法和AHP的浙江省中医非药物疗法医保支付的可行性研究
Feasibility Study on Medical Insurance Payment of Non-drug Therapy of TCM in Zhejiang Based on Delphi Method and AHP
投稿时间:2020-05-04  
DOI:10.16466/j.issn1005-5509.2021.05.007
中文关键词: 非药物疗法  医保目录  浙江省  评价  医保支付方式  Delphi法  层次分析法
英文关键词: non-drug therapy  medical insurance catalogue  Zhejiang Province  assessment  medical payment method  Delphi method  analytic hierarchy process
基金项目:浙江省中医药科技计划项目(2019ZB078);浙江省教育厅一般科研项目(Y201737259);杭州市社科规划“人才培育计划”专项课题(2017RCZX36)
作者单位
胡小璞 杭州师范大学 杭州 311121 
胡晓丽 嘉兴市烟草专卖局 
陈燕 杭州师范大学 杭州 311121 
沈歆 杭州师范大学 杭州 311121 
邵平 杭州师范大学 杭州 311121 
边森森 杭州师范大学 杭州 311121 
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中文摘要:
      [目的]对浙江省临床常用的中医非药物疗法进行筛选,论证纳入医保支付的可行性。[方法]采用访谈法对42项非药物疗法进行初步筛选,以Delphi法、层次分析法对“临床诊疗必需”“服务可及”“能避免滥用”“公众能接受”“效果确定”“费用适宜”和“医保基金可持续”7个评价指标进行赋权和打分,综合评价各类别非药物疗法的优劣次序。[结果]初筛的20项疗法归为含药类、治未病类、针刺类和灸法类,经由20名权威专家进行两轮咨询。7个指标各疗法的得分排序不尽一致,17项疗法有超过70%的专家建议进入甲类(医保偿付全部费用)。综合两轮得分较高的有含药类3项,包括中药封包治疗、中药热奄包治疗、中药蒸汽浴治疗;治未病2项,即中医体质辨识、中医整体调摄方案(套餐);灸法类2项,督灸(包括大灸)和雷火灸。针刺类普遍得分和熟悉程度得分较低,但进甲类意见较为统一,也增加了得分相对靠前的2项(手指点穴和芒针),最终建议纳入医保支付的中医非药物疗法共9项,包括中药封包治疗、中药热奄包治疗、中药蒸汽浴治疗、中医体质辨识、中医整体调摄方案(套餐)、手指点穴、芒针、督灸(包括大灸)和雷火灸。[结论]基于Delphi法和层次分析法对非药物疗法进行筛选,有助于验证浙江省中医医疗技术的推广应用成效,并为有关部门按“准入法”修订浙江省基本医疗保险诊疗项目目录提供决策依据。
英文摘要:
      [Objective] To select the common non-drug therapies of traditional Chinese medicine(TCM) in Zhejiang and demonstrate the feasibility of including them into medical insurance payment.[Methods] Interview method was used to select 42 non-drug therapies, and Delphi method and analytic hierarchy process were used to give weights and score 7 assessment of indicators of “clinical diagnosis and treatment necessary” “service accessible” “to avoid abuse” “public acceptable” “effect determined” “cost appropriate” and “medical insurance fund sustainable” comprehensively, to evaluate the advantages and disadvantages of each type of non-drug therapy.[Results] The 20 preliminary screening therapies were classified into four categories: Medicine, preventive treatment of disease, acupuncture and moxibustion therapy, and two rounds of consultation were conducted by 20 authoritative experts. The ranking of the scores of the 7 indicators was not the same. More than seventy percent of the experts suggested that the 17 therapies should enter class A(medical insurance pays for all expenses). In the two rounds, there were 3 kinds of medicine(Chinese medicine packets, Chinese herbal hot package treatment, Chinese medicine steam bath treatment), 2 kinds of preventive treatment of disease(physical identification and whole recuperation package)and 2 kinds of moxibustion therapy(Du-moxibustion and thunder-fire moxibustion) scored higher. Acupuncture had a relatively low general score and low familiarity score, but the opinions of their entering class A were relatively unified, and 2 of them(acupoint pressure and elongated needle) with relatively high scores were added, resulting in 9 therapies proposed to be included in the medical insurance payment, including Chinese medicine packets, Chinese herbal hot package treatment, Chinese medicine steam bath treatment, physical identification, whole recuperation package, acupoint pressure, elongated needle, Du-moxibustion and thunder-fire moxibustion.[Conclusion] Screening non-drug therapies based on Delphi method and analytic hierarchy process is helpful to verify the promotion and application effect of TCM technology in Zhejiang Province, and provide decision-making basis for relevant departments to revise the list of diagnosis and treatment items of basic medical insurance in Zhejiang Province according to the "access law".
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