CAJ | 학술논문

目的：本研究基于课题前期专家咨询和文献查阅，旨在从定点医疗机构中医医师的视角，进一步分析医疗保险对中医药发展产生的影响，并提出具体建议，以促进中医药与医疗保险的良性发展。方法：采用问卷调查的方法，对全国253名医疗保险定点医疗机构中医医师在中医药和医疗保险关联方面的看法进行调查研究，使用频数统计等方法对数据进行处理。结果：医保定点后参保患者已成为医院的主要服务人群（73.5%），医院（68.4%）和中医师（41.9%）的收入均有所增长，有助于中医医院做大做强（63.6%）；参保患者主要因疗效（37.9%）和安全（24.1%）而选择中医药治疗，医保报销比例的影响较低（1.2%）；中医药医保报销范围需进一步扩大，如中药院内制剂（90.5%）和代煎费（78.3%）等。结论：在“全民医保”背景下，医疗保险对中医药发展影响越来越大，中医药应通过标准化等手段保障安全和提高疗效，同时医疗保障政策和医疗保险管理服务标准的制定也需考虑中医药的特性，鼓励提供中医药服务。
목적：본연구기우과제전기전가자순화문헌사열，지재종정점의료궤구중의의사적시각，진일보분석의료보험대중의약발전산생적영향，병제출구체건의，이촉진중의약여의료보험적량성발전。방법：채용문권조사적방법，대전국253명의료보험정점의료궤구중의의사재중의약화의료보험관련방면적간법진행조사연구，사용빈수통계등방법대수거진행처리。결과：의보정점후삼보환자이성위의원적주요복무인군（73.5%），의원（68.4%）화중의사（41.9%）적수입균유소증장，유조우중의의원주대주강（63.6%）；삼보환자주요인료효（37.9%）화안전（24.1%）이선택중의약치료，의보보소비례적영향교저（1.2%）；중의약의보보소범위수진일보확대，여중약원내제제（90.5%）화대전비（78.3%）등。결론：재“전민의보”배경하，의료보험대중의약발전영향월래월대，중의약응통과표준화등수단보장안전화제고료효，동시의료보장정책화의료보험관리복무표준적제정야수고필중의약적특성，고려제공중의약복무。
This study was based on the project prophase of expert consultation and literature consult, and aimed to analyze the medicine establishment from the perspective of traditional Chinese medicine (TCM) doctors, in order to further study the influence of medical insurance on the development of TCM. Detailed suggestions were made in or-der to promote the benign development trend of TCM and medical insurance. Questionnaire survey was used in the investigation on perceptions of TCM related with medical insurance among 253 TCM doctors in appointed medical institution of medical insurance. Data was processed with frequency statistics. The results showed that after becoming the appointed medical institution of medical insurance, the medical insurance patients have become the main service group (73.5%) of hospitals (68.4%) and incomes of TCM doctors (41.9%) have increased, which contribute to TCM hospitals of becoming bigger and stronger (63.6%). The medical insurance patients have chosen TCM treatment main-ly for its curative effect (37.9%) and safety (24.1%). The influence of reimbursement ratio in medical insurance was relatively low (1.2%). The reimbursement range of TCM medical insurance needs to be further expanded, such as Chinese medicine nosocomial preparation (90.5%), decoction preparation fee (78.3%), and etc. It was concluded that under the background of universal health coverage, medical insurance plays a more and more important role in the development of TCM. And TCM should ensure its safety and improve its curative effect through the standardization of TCM and other measures. Meanwhile, the formulation of medical security policy and medical insurance management service standards should also consider the characteristics of TCM, and encourage the service of TCM.